Time patterns of recurrence and second primary tumors in a large cohort of patients treated for oral cavity cancer

Presentation and outcomes of second primary malignancies (SPMs) in locally advanced oral cavity squamous carcinoma (LA-OSCC): Secondary analysis of a phase III randomised control trial (NCT00193843)

BACKGROUND

Second Primary Malignancies (SPMs) are a common cause of morbidity and mortality in Head & Neck Squamous Carcinoma (HNSCC). Prospective data on incidence, outcomes and prognostic factors is sparse. The current publication summarizes data on 83 SPMs which developed on follow up among patients accrued on a Phase III Randomized Controlled Trial testing treatment intensification in Oral Cavity Squamous Carcinoma (OSCC).

PATIENTS AND METHODS

Nine hundred patients of OSCC accrued between 2005-2013 were followed up as part of the trial protocol. Standard clinical criteria were used to determine SPM occurrence. Clinicopathological and demographic variables were summarized using descriptive statistics and analysed using measures of central tendency and dispersion. Outcomes of interest included Overall-Survival (OS) and Progression-Free-Survival (PFS) post SPM diagnosis and were analysed using the Kaplan-Meier method and factors of prognostic significance were compared using the log-rank test and multivariate analysis thereafter.

RESULTS

The median follow-up of surviving patients was 95.9 months {(IQR) = 76.1-122.4 months}. A total of 83 SPMs were detected at a median time-to-occurrence of 48 months (IQR-20-87 months) (Cumulative Incidence -11 % at 5 years). The Head & Neck was the most common site of SPM. The 2-year Kaplan Meier estimates of OS and PFS post diagnosis of SPM were 30.3 % (95 %CI-20.9 %-43.9 %) and 21.6 % (95 %CI-13.8 %-34 %) respectively. Multivariate analysis revealed time-to-development of SPM more than 2 years and surgical management of SPM to be associated with superior PFS.

CONCLUSIONS

SPMs can cause major morbidity and mortality in OSCC survivors. Strategies need to be developed to gear towards early detection and aggressive salvage.

Impact of intraoperative NBI on complete resections and recurrence in oral and oropharyngeal cancer

PURPOSE

The aim of this study was to assess the number of complete resections and recurrence rates in oral and oropharyngeal squamous cell carcinoma treated with intraoperative narrow-band-imaging.

MATERIALS AND METHODS

In this observational study, superficial resection margins of oral and oropharyngeal squamous cell carcinoma were intraoperatively defined using narrow-band-imaging. The number of complete resections was assessed. Patients were followed up for at least 5 years: disease free survival and the cumulative incidence of local recurrence were recorded.

RESULTS

93 squamous cell carcinoma were considered. Surgical resection was complete in 84.9 % of cases. The 5-years disease free survival was 76.2 % (95%CI: 67.1 %-84.4 %). Cumulative incidence of local recurrence was 9.7 % (95%CI: 4.7 %-16.7 %), lower compared to previous literature: it was higher in patients over 68 years (14.3 %, 95%CI: 6.2 %-25.6 % vs 4.5 %, 95%CI: 0.8 %-13.8 %) although without statistically significance.

CONCLUSIONS

In oral and oropharyngeal squamous cell carcinoma surgery, narrow-band imaging is a valuable tool for accurately identifying the true superficial extent of the tumor, facilitating complete resection and potentially reducing local recurrence.

Determinants of oral cavity cancer recurrence in Pakistan: findings from a cross-sectional study using an institutional cancer registry

INTRODUCTION

Pakistan has a high prevalence of oral cavity cancer (OCC) with a significant recurrence rate. This study aims to explore the factors associated with OCC recurrence in Karachi, Pakistan.

METHODS

This cross-sectional study was conducted at the Aga Khan University Hospital (AKUH) Karachi, Pakistan, using data from the AKUH Cancer Registry. A total of 1692 biopsy-confirmed cases of OCC including cancers of mucosal lip, tongue, gum, oral cavity floor, palate and other subsites like retromolar area, diagnosed between May 2011 and December 2020, were included in our study.

RESULTS

Of the 1692 patients, 611 (36.1%) experienced recurrence. Being male was associated with significantly increased odds of OCC recurrence compared to being female (Prevalence Odds Ratio (POR) = 1.70, 95% CI = 1.25-2.30). Moderately and poorly differentiated tumors had higher odds of recurrence (POR = 1.44, 95% CI = 1.02-2.02 and POR = 2.35, 95% CI = 1.49-3.71 respectively). Lymph node involvement was significantly associated with increased odds of recurrence. Patients with N1, N2 and N3 lymph node involvement had significantly higher odds of recurrence (POR = 1.45, 95% CI = 1.02-2.07 for N1, POR = 2.12, 95% CI = 1.57-2.87 for N2 and POR = 3.50, 95% CI = 1.72-7.11 for N3 respectively). Surgical treatment outside AKUH was associated with higher OCC recurrence (POR = 1.68, 95% CI = 1.12-2.50). Surgery alone (POR = 0.02, 95% CI = 0.00-0.16) and in combination with radiation (POR = 0.02, 95% CI = 0.00-0.16) or chemoradiation (POR = 0.04, 95% CI = 0.01-0.33) was protective against recurrence.

CONCLUSION

This study's findings identified factors increasing oral cavity cancer recurrence, highlighting the importance of considering these factors in the management and follow up of patients with OCC. Understanding these factors will not only help enhance patient care, but also improve patient education about their disease prognosis. Further research is needed to explore the underlying mechanisms and develop targeted interventions to improve outcomes for patients with OCC.

An exploration of nursing and Allied Health Professional (AHP)-led post-treatment surveillance and survivorship care for people with head and neck cancer-a scoping review

A scoping literature review was undertaken to identify the current evidence base on the role of nursing and allied health professionals (AHPs) in delivering surveillance and survivorship services within head and neck cancer (HNC) care following treatment.

METHOD

This review was undertaken according to the Joanna Briggs Institute (JBI) guidance on the conduct of scoping reviews. An initial database search was undertaken between December 2023 and February 2024 and then repeated in November 2024. Databases included CINAHL, EMBASE, and MEDLINE. A focused grey literature search targeting other material including conference abstracts was also completed. Articles were included which were written in English. The search was not restricted to year of publication/production or methodology to ensure the greatest scope of materials. Relevant articles were reviewed, and narratives summarised.

RESULTS

A total of 144 articles were identified through initial database screening and subsequently 29 were eligible for full text review with 3 meeting the inclusion criteria. All 3 investigated follow-up care led by nurses or AHPs for people treated for HNC. Two of these articles described alternative models of surveillance/survivorship care. One article aimed to investigate professional's perceptions on post-treatment disease surveillance by nurses and AHPs. Outcome measures included quantitative results on quality of life measures (QoL) and disease re-sectability and qualitative data obtained via an online survey which included free text response options. Limited results demonstrated that people were satisfied that nurse or AHP led care could meet their needs and improve psychosocial adjustment and QoL. There was no evidence to suggest the rate of cancer recurrence detection is reduced when a nurse or AHP is the lead professional involved in follow up surveillance. No articles explored the experience of people receiving this model of care in detail.

CONCLUSION

A small body of evidence suggests that nursing and AHP professionals can provide an effective and safe service of follow-up care in HNC management. Clinics led by advanced practitioners (AP) may provide an opportunity to deliver enhanced care and meet QoL needs. Within a rapidly developing and changing landscape of post-treatment surveillance nurses and AHPs are well placed to provide advice, support and interventions for treatment effects. More evidence is needed to develop new models of risk stratified nursing/AHP surveillance and the competencies required to ensure the complex holistic needs of individuals are safely and effectively met.

Prevalence and correlates of fear of recurrence among oral and oropharyngeal cancer survivors

PURPOSE

Fear of recurrence (FoR) is a prevalent and difficult experience among cancer patients. Most research has focused on FoR among breast cancer patients, with less attention paid to characterizing levels and correlates of FoR among oral and oropharyngeal cancer survivors. The purpose was to characterize FoR with a measure assessing both global fears and the nature of specific worries as well as evaluate the role of sociodemographic and clinical factors, survivorship care transition practices, lifestyle factors, and depressive symptoms in FoR.

METHODS

Three hundred eighty-nine oral and oropharyngeal survivors recruited from two cancer registries completed a survey assessing demographics, cancer treatment, symptoms, alcohol and tobacco use, survivorship care practices, depression, and FoR.

RESULTS

Forty percent reported elevated global FoR, with similar percentages for death (46%) and health worries (40.3%). Younger, female survivors and survivors experiencing more physical and depressive symptoms reported more global fears and specific fears about the impact of recurrence on roles, health, and identity, and fears about death. Depression accounted for a large percent of the variance. Lower income was associated with more role and identity/sexuality worries, and financial hardship was associated with more role worries.

CONCLUSIONS

FoR is a relatively common experience for oral and oropharyngeal cancer survivors. Many of its correlates are modifiable factors that could be addressed with multifocal, tailored survivorship care interventions.

IMPLICATIONS FOR CANCER SURVIVORS

Assessing and addressing depressive symptoms, financial concerns, expected physical symptoms in the first several years of survivorship may impact FoR among oral and oropharyngeal cancer survivors.

Sentinel lymph node biopsy in early-stage oral squamous cell carcinoma: A retrospective single-center analysis

Sentinel lymph node biopsy (SLNB) is increasingly incorporated in European national guidelines for the management of the clinically node-negative neck (cN0) in early-stage oral squamous cell carcinoma (OSCC). In Germany, SLNB in OSCCs is not yet routinely performed. This study aimed to evaluate the clinical outcome of SLNB in a German cohort. Patients with primary early-stage OSCC who underwent tumor resection and SLNB were retrospectively analyzed. Clinical-pathological characteristics were documented. Primary endpoints were sensitivity and the negative predictive value (NPV). A total of 46 patients with a mean age of 62.3 (±14.5) years met the inclusion criteria. Most tumors were located in the tongue (63.0%). Bilateral drainage from a lateral tumor was observed in three cases (6.5%), and sentinel lymph node metastasis was detected in three patients (6.5%). Mean follow-up for all patients was 13.8 months (±9.6). One patient developed regional recurrence following a negative SLNB during the observation period, leading to an NPV of 0.98 and a sensitivity of 75.0%. The 2-year neck-specific relapse-free survival was 92.8%. SLNB in early-stage OSCC is a reliable diagnostic tool of the cN0 neck, ensuring a high NPV and RFS. SLNB can be advantageous in comparison to elective neck dissection due to the detection of contralateral lymph drainage.

Antihypertensive agent losartan promotes tongue squamous cell carcinoma cell proliferation via EGFR/ERK1/2/cyclin D1 signaling axis

OBJECTIVE

To study the effects of losartan, an angiotensin II receptor blocker, in the SCC4 and SCC25 human tongue squamous cell carcinoma cell lines.

METHODS

Cell proliferation was measured by MTS/PMS activity and trypan blue exclusion assays. The levels of the cell proliferation marker, cyclin D1, were analyzed by western blotting. Apoptosis was assessed by caspase-3 activation and Annexin V-FITC/propidium iodide double staining. Activation of epidermal growth factor receptor (EGFR) and ERK1/2 was validated by western blotting.

RESULTS

Moderate concentrations of losartan enhanced the proliferation of SCC4 and SCC25 cells. However, high losartan concentrations induced apoptosis in SCC4 cells. Losartan activated the EGFR/ERK1/2/cyclin D1 signaling axis, which in turn promoted cell proliferation. Afatinib (EGFR inhibitor) and U0126 (ERK1/2 inhibitor) abolished losartan-induced cell proliferation. In contrast, UC2288 (p21 inhibitor) enhanced it.

CONCLUSIONS

Losartan exhibited dual effects on tongue squamous cell carcinoma cells. Moderate losartan concentrations facilitated cell proliferation, whereas high concentrations induced cytotoxicity in tongue carcinoma cells.

Improving detection of oral lesions: Eye tracking insights from a randomized controlled trial comparing standardized to conventional approach

BACKGROUND

Early detection of oral cancer (OC) or its precursors is the most effective measure to improve outcome. The reasons for missing them on conventional oral examination (COE) or possible countermeasures are still unclear.

METHODS

In this randomized controlled trial, we investigated the effects of standardized oral examination (SOE) compared to COE. 49 dentists, specialists, and dental students wearing an eye tracker had to detect 10 simulated oral lesions drawn into a volunteer's oral cavity.

RESULTS

SOE had a higher detection rate at 85.4% sensitivity compared to 78.8% in the control (p = 0.017) due to higher completeness (p < 0.001). Detection rate correlated with examination duration (p = 0.002).

CONCLUSIONS

A standardized approach can improve systematics and thereby detection rates in oral examinations. It should take at least 5 min. Perceptual and cognitive errors and improper technique cause oral lesions to be missed. Its wide implementation could be an additional strategy to enhance early detection of OC.

Evolution of phenotypic plasticity leads to tumor heterogeneity with implications for therapy

Cancer is a significant global health issue, with treatment challenges arising from intratumor heterogeneity. This heterogeneity stems mainly from somatic evolution, causing genetic diversity within the tumor, and phenotypic plasticity of tumor cells leading to reversible phenotypic changes. However, the interplay of both factors has not been rigorously investigated. Here, we examine the complex relationship between somatic evolution and phenotypic plasticity, explicitly focusing on the interplay between cell migration and proliferation. This type of phenotypic plasticity is essential in glioblastoma, the most aggressive form of brain tumor. We propose that somatic evolution alters the regulation of phenotypic plasticity in tumor cells, specifically the reaction to changes in the microenvironment. We study this hypothesis using a novel, spatially explicit model that tracks individual cells' phenotypic and genetic states. We assume cells change between migratory and proliferative states controlled by inherited and mutation-driven genotypes and the cells' microenvironment. We observe that cells at the tumor edge evolve to favor migration over proliferation and vice versa in the tumor bulk. Notably, different genetic configurations can result in this pattern of phenotypic heterogeneity. We analytically predict the outcome of the evolutionary process, showing that it depends on the tumor microenvironment. Synthetic tumors display varying levels of genetic and phenotypic heterogeneity, which we show are predictors of tumor recurrence time after treatment. Interestingly, higher phenotypic heterogeneity predicts poor treatment outcomes, unlike genetic heterogeneity. Our research offers a novel explanation for heterogeneous patterns of tumor recurrence in glioblastoma patients.

Spatial heterogeneity of tumor cells and the tissue microenvironment in oral squamous cell carcinoma

PURPOSE

This study describes the morphologic and phenotypic spatial heterogeneity of tumor cells and the tissue microenvironment (TME), focusing on immune infiltration in OSCCs.

STUDY DESIGN

Patients with OSCCs and planned surgical tumor resection were eligible for the study. Two biopsies each from the tumor center and the tumor rim were obtained. Immunohistochemical characterization of tumor and immune cells was performed using a panel of immunohistochemical markers.

RESULTS

Thirty-six biopsies were obtained from the 9 patients. All patients showed an individual marker expression profile with ITH. Within the same biopsy, the CPS and TPS scores showed relevant variations in PD-L1 expression. Comparisons between the tumor center and rim revealed significant differences in the up/downregulation of p53. Marker expression of patients with recurrences clustered similarly, with the higher expression of FoxP3, IDO, CD4, CD68, and CD163 at the tumor rim.

CONCLUSION

OSCCs were found to exhibit relevant ITH involving both tumor cells and TME, suggesting that biomarker analysis of multiple tumor regions may be helpful for clinical decision making and tumor characterization. The analysis of multiple spots within a biopsy is recommended for a reliable determination of PD-L1 expression and other biomarkers, impacting current clinical assessments.

Second primary squamous cell carcinoma of the oral cavity - a retrospective cohort study of therapeutic procedures and oncological outcome

OBJECTIVES

In the presented study, the occurrence rates of second primary oral carcinomas and their prognostic relevance were analyzed.

MATERIALS AND METHODS

All patients with surgically treated oral squamous cell carcinomas within the years 2010 and 2022 in our department were included in this retrospective cohort study. Two groups were designed including patients with second primary carcinomas and patients with local tumor recurrences. Occurrence rates, tumor stages and applied therapies were assessed. Primary outcome was overall survival in dependence of the index tumor. Secondary outcomes were overall survival in dependence of local recurrences or second primary tumors.

RESULTS

An overall number of 908 patients was included in the analysis. 98 patients (10.8%) developed a second primary oral squamous cell carcinoma. Patients with second primary tumors presented significantly (p < 0.001) better overall survival in dependence of the index tumor compared to patients suffering from local recurrences. There was no significant difference in overall survival (p = 0.4) in dependence of the date of second primary tumor or local recurrence. Patients with second primary tumors were more likely to receive surgery-based therapy compared to patients with local recurrences who more frequently received definitive radiotherapy.

CONCLUSION

Our data indicates different clinical courses in terms of therapy and survival of patients suffering from second primary tumors compared to patients with local tumor recurrences. This may be due to a more aggressive biology of local recurrences and earlier detection of second primaries due to oncological follow-up of the index tumor.

CLINICAL RELEVANCE

The differentiation of local tumor recurrences and second primary tumors is of clinical relevance, as applicable therapies and resulting prognosis may differ significantly.

Clinical outcomes and prognostic factors of head and neck squamous cell carcinoma: a ten-year follow-up study

Traditional guidelines for determining the prognosis of patients with head and neck squamous cell carcinoma (HNSCC) are used to make therapeutic decisions. However, only 50% of the patients had lived for more than five years. The present study aimed to analyze the correlation of traditional prognostic factors such as tumor size, histological grading, regional metastases, and treatment with the survival of patients with HNSCC. A total of 78 patients diagnosed with HNSCC were followed up for 10 years after diagnosis and treatment. The health status of the patients was tracked at four time points, and according to the evolution of the patients and their final clinical status, we performed a prognostic analysis based on the clinical outcomes observed during the follow-up period. The final study cohort comprised 50 patients. Most patients had tumors < 4 cm in size (64%) and no regional metastases (64%); no patients had distant metastases at the time of diagnosis. Most individuals had tumors with good (48%) and moderate (46%) degrees of malignancy. At the end of the follow-up period, only 14% of the patients were discharged, 42% died of the tumor, and 44% remained under observation owing to the presence of a potentially malignant disorder, relapse, or metastases. This analysis showed that traditional prognostic factors were not accurate in detecting subclinical changes or predicting the clinical evolution of patients.

Prediction of postoperative recurrence of oral cancer by artificial intelligence model: Multilayer perceptron

BACKGROUND

Postoperative recurrence of oral cancer is an important factor affecting the prognosis of patients. Artificial intelligence is used to establish a machine learning model to predict the risk of postoperative recurrence of oral cancer.

METHODS

The information of 387 patients with postoperative oral cancer were collected to establish the multilayer perceptron (MLP) model. The comprehensive variable model was compared with the characteristic variable model, and the MLP model was compared with other models to evaluate the sensitivity of different models in the prediction of postoperative recurrence of oral cancer.

RESULTS

The overall performance of the MLP model under comprehensive variable input was the best.

CONCLUSION

The MLP model has good sensitivity to predict postoperative recurrence of oral cancer, and the predictive model with variable input training is better than that with characteristic variable input.

Temporal and spatial patterns of recurrence in oral squamous cell carcinoma, a single-center retrospective cohort study in China

BACKGROUND

Oral squamous cell carcinoma (OSCC) is an invasive cancer with a high recurrence rate. Most clinical studies have focused on the prognosis of patients with OSCC, few have investigated the causes and interventions that affect the recurrence. Our study is to explore the temporal and spatial patterns of recurrence in OSCC.

METHODS

234 OSCC patients with recurrence in our hospital and 64 OSCC patients with recurrence in TCGA database were included in the study. Log-rank test and Multivariate Cox Regression Analysis were used to determine whether there was a significant difference between each selected demographic or clinical factors and recurrence. The Kaplan-Meier method was used to plot survival curves for each recurrence interval.

RESULTS

The proportion of OSCC patients in clinical and TCGA with early recurrence was 93.6% and 84.4%, respectively. Age, chewing betel nut, previous radiotherapy, histopathological grading of the primary tumor (poorly differentiated), lymph node metastasis and postoperative infection were found to be associated with the timing of recurrence. It was found that tongue cancer has more regional recurrences, while buccal cancer is mostly local and loco-regional recurrences. The earlier the recurrence, the greater the possibility of local-regional recurrence and the worse the prognosis.

CONCLUSION

Most of recurrent OSCC patients present early recurrence (< 18 months) with poor prognosis, and early recurrence is more prone to local recurrence. Moreover, recurrence site is related with primary site of OSCC.

Carcinoma buccal mucosa treated with definitive hypofractionated accelerated radiotherapy: a retrospective analysis of treatment outcomes

Introduction

Oral cancer is a major public health concern in India. Both conventional and altered fractionation radiotherapy schedules have been used in curative treatment of oral cancer. This study aimed to retrospectively evaluate the clinical profile and treatment outcomes of patients with carcinoma buccal mucosa who underwent treatment with definitive hypofractionated accelerated radiotherapy.

Methods

A total of 517 patients treated from January 2011 to December 2016 were eligible for the analysis. All patients were treated with definitive hypofractionated accelerated radiotherapy schedule of 5,250 cGy in 15 fractions over 3 weeks. Survival estimates were generated using the Kaplan-Meier method.

Results

At a median follow-up of 77.4 months, 473 (91.5%) patients attained complete remission with radiation therapy. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 69% and 80.5%, respectively. The 5-year OS for stage I, II, III and IVa tumours was 80.3%, 84.4%, 81.4% and 73.7%, respectively, and the DFS was 75.7%, 73.2%, 69.6% and 60.2%, respectively. Age >50 years was found to be a significant factor affecting DFS (P = 0.026) and OS (P = 0.048) in multivariate analysis. Fifty-three (10.3%) patients developed osteoradionecrosis of the mandible.

Conclusion

Excellent outcome could be achieved in less-aggressive, low-volume carcinoma of the buccal mucosa with radical accelerated hypofractionated radiotherapy. A radiotherapy schedule over a 3-week period is useful in high-volume centres.

Ultrasound Is Beneficial to Determine Lymphadenopathy in Oral Cancer Patients after Radiotherapy

The present study aimed to investigate whether the addition of ultrasound (US) +/- fine needle aspiration (FNA) to magnetic resonance imaging (MRI) or computed tomography (CT) improves the diagnostic accuracy in assessing neck lymphadenopathy in oral cancer patients after neck irradiation. We retrospectively reviewed oral cancer patients who had neck lymphadenopathy after radiotherapy (RT) or chemoradiation therapy (CRT) from February 2008 to November 2019. The following diagnostic modalities were assessed: (1) MRI/CT, (2) MRI/CT with a post-RT US predictive model, and (3) MRI/CT with US + FNA. The receiver operating characteristic (ROC) curves were used to assess the diagnostic performance. A total of 104 irradiation-treated oral cancer patients who subsequently had neck lymphadenopathy were recruited and analyzed. Finally, there were 68 (65%) malignant and 36 (35%) benign lymphadenopathies. In terms of the diagnostic performance, the area under the ROC curves (C-statistics) was 0.983, 0.920, and 0.828 for MRI/CT with US + FNA, MRI/CT with a post-RT US predictive model, and MRI/CT, respectively. The addition of US to MRI/CT to evaluate cervical lymphadenopathy could achieve a better diagnostic accuracy than MRI/CT alone in oral cancer patients after neck irradiation.

A nationwide study on cancer recurrences, second primary tumours, distant metastases and survival after treatment for primary head and neck cancer in the Netherlands

INTRODUCTION

There is no consensus on the optimal duration of post-treatment follow-up after head and neck cancer (HNC). To generate site-specific input for follow-up guidelines, this study describes the incidence and timing of manifestations of disease during five years of follow-up.

METHODS

All patients diagnosed with HNC in the Netherlands in 2015 were selected from the Netherlands Cancer Registry. The follow-up events local recurrence (LR), regional recurrence (RR), second primary tumour (SPT), distant metastasis (DM) and death were studied per follow-up-year. The cumulative incidence of these events was calculated using competing risk analyses, with LR, RR and SPT of the head and neck (SPHNC) as events and SPT outside the head-neck (SPOHN), DM and death as competing events. Analyses were performed for oral cavity-, oropharynx-, larynx- and hypopharynx squamous cell carcinoma (SCC), and all HNC patients.

RESULTS

The 1-, 1.5-, and 2-year cumulative incidence of an event (LR, RR, SPHNC) were 10% (95%CI 8-13), 12% (95%CI 10-15), and 13% (95%CI 10-16) for oral cavity SCC; 6% (95%CI 4-9), 10% (95%CI 7-14), and 11% (95%CI 8-15) for oropharynx SCC; 7% (95%CI 5-10), 11% (95%CI 9-15), and 13% (95%CI 10-16) for larynx SCC and 11% (95%CI 6-19), 19% (95%CI 12-27), and 19% (95%CI 12-27) for hypopharynx SCC.

CONCLUSIONS

One year of follow-up for oral cavity SCC, and 1.5 years for oropharynx-, larynx-, and hypopharynx SCC suffices for the goal of detecting disease manifestations after treatment. More research into other aspects of follow-up care should be performed to determine the optimal follow-up regimen.

Surveillance of head neck cancer: Case for personalized and standardized surveillance

Although surgery, radiotherapy, chemotherapy, or combined treatment often elicits an initial satisfactory response, relapses are frequently observed within two years. Current surveillance methods, including clinical exams and imaging evaluations, have not unambiguously demonstrated a survival benefit, most probably due to a lack of sensitivity in detecting very early recurrence. Current guidelines advise post-treatment surveillance of head and neck cancer (HNC) patients should involve scheduled appointments with a variety of practitioners. The benefits of prolonged routine follow-up on survival have not been proven. Increasing numbers of HNC survivors raise the burden to provide efficient and effective care.

Plasma cell-free DNA methylome profiling in pre- and post-surgery oral cavity squamous cell carcinoma

Head and neck squamous cell carcinoma (HNSCC), a highly heterogeneous disease that involves multiple anatomic sites, is a leading cause of cancer-related mortality worldwide. Although the utility of noninvasive biomarkers based on circulating cell-free DNA (cfDNA) methylation profiling has been widely recognized, limited studies have been reported so far regarding the dynamics of cfDNA methylome in oral cavity squamous cell carcinoma (OCSCC). It is hypothesized in this study that comparison of methylation profiles in pre- and postsurgery plasma samples will reveal OCSCC-specific prognostic and diagnostic biomarkers. As a strategy to further prioritize tumor-specific targets, top differential methylated regions (DMRs) were called by reanalyzing methylation data from paired tumor and normal tissue collected in the the cancer genome atlas head-neck squamous cell carcinoma (TCGA) head and neck cancer cohort. Matched plasma samples from eight patients with OCSCC were collected at Moffitt Cancer Center before and after surgical resection. Plasma-derived cfDNA was analyzed by cfMBD-seq, which is a high-sensitive methylation profiling assay. Differential methylation analysis was then performed based on the matched samples profiled. In the top 200 HNSCC-specific DMRs detected based on the TCGA data set, a total of 23 regions reached significance in the plasma-based DMR test. The top five validated DMR regions (ranked by the significance in the plasma study) are located in the promoter regions of genes PENK, NXPH1, ZIK1, TBXT, and CDO1, respectively. The genome-wide cfDNA DMR analysis further highlighted candidate biomarkers located in genes SFRP4, SOX1, IRF4, and PCDH17. The prognostic relevance of candidate genes was confirmed by survival analysis using the TCGA data. This study supports the utility of cfDNA-based methylome profiling as a promising noninvasive biomarker source for OCSCC and HNSCC.

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

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

Nuclear Epidermal Growth Factor Receptor Overexpression as a Survival Predictor in Oral Squamous Cell Carcinoma

The aim of this study was to determine, by immunohistochemical methods, the expression of nEGFR and markers of cell proliferation (Ki-67), cell cycle (mEGFR, p53, cyclin D1), and tumor stem cells (ABCG2) in 59 pathohistological samples of healthy oral mucosa, 50 oral premalignant changes (leukoplakia and erythroplakia), and 52 oral squamous cell carcinomas (OSCC). An increase in the expression of mEGFR and nEGFR was found with the development of the disease (p < 0.0001). In the group of patients with leukoplakia and erythroplakia, we found a positive correlation between nEGFR and Ki67, p53, cyclin D1, and mEGFR, whereas in the group of patients with OSCC, we found a positive correlation between nEGFR and Ki67, mEGFR (p < 0.05). Tumors without perineural (PNI) invasion had a higher expression of p53 protein than tumors with PNI (p = 0.02). Patients with OSCC and overexpression of nEGFR had shorter overall survival (p = 0.004). The results of this study suggest a potentially important independent role of nEGFR in oral carcinogenesis.

Individualised follow-up for head and neck cancer-design of a prospective cohort study to assess its feasibility

INTRODUCTION

It is a common practice for many cancer types to monitor patients after treatment to detect new disease manifestations early. For head and neck cancer (HNC), however, long-term routine follow-up is up for debate for several reasons. The benefits of prolonged routine follow-up on survival have not been proven. Also, cancer follow-up is putting increasing pressure on healthcare resources due to rising incidence and survival rates. Therefore, this study investigates a novel follow-up approach among HNC patients, giving them the opportunity to choose their own follow-up programme.

METHODS AND ANALYSIS

HNC patients are offered a decision-aided choice between standardised or individualised follow-up after 1.5 years of uncomplicated guideline-prescribed follow-up. Standardised follow-up entails continuing the 5-year guideline-prescribed schedule. Individualised follow-up means the patient only attends the outpatient clinic on their own initiative in case of physical symptoms or supportive care needs. Patients are educated on self-examination and when a control visit is necessary. The primary outcome measure is the feasibility of offering patients this choice. Secondary outcome measures are quality of life, costs, productivity loss and detection of new disease.

ETHICS AND DISSEMINATION

We believe that it is essential to let patients determine their follow-up programme based on their own values and preferences. If this choice is feasible, it can be implemented and investigated in other HNC care centres.

TRIAL REGISTRATION NUMBER

NCT05386225.

Circulating tumor cells as a predictor for poor prognostic factors and overall survival in treatment naïve oral squamous cell carcinoma patients

OBJECTIVE

The aim of this study was to investigate the presence of circulating tumor cells (CTCs) and their correlation with prognostic factors and clinical outcomes in treatment-naive patients with oral squamous cell carcinoma.

STUDY DESIGN

CTCs were isolated using OncoDiscover technique from presurgically obtained peripheral blood of 152 patients with treatment naïve oral squamous cell carcinoma. Sensitivity analysis was performed by including 40 healthy controls. CTCs cutoff values for clinicopathologic factors were obtained from receiver operating characteristic curves. Multivariate models determined the significance of CTC as independent variables. Kaplan-Meier analysis differentiated in overall survival between CTC values corresponding to the stage.

RESULTS

Sensitivity, specificity, and accuracy of CTC detection were 94.32%, 98%, and 95.17%, respectively. Platform differentiated true positives at >3.5 CTCs (P < .00001). CTCs above 20.5 were suggestive of nodal metastasis (P < .0001) with a linear trend for detecting occult metastasis (P = .061). Early and advanced stages could be differentiated by >13.5 CTCs (P < .0001). Elevated CTCs were significantly associated with extranodal extension (>21.45 CTCs, P = .025), perineural invasion (>19.35 CTCs, P = .049), and depth of invasion (>12.5 CTCs, P = .0038). Median survival was reduced by 19 months when CTCs were >13.

CONCLUSIONS

Preoperative CTC levels demonstrated a strong correlation with adverse clinicopathology factors and suggested its role as a sensitive prognostic marker to predict survival outcome and disease progress.

Downregulation of circLPAR3 inhibits tumor progression and glycolysis by liberating miR‐144‐3p and upregulating LPCAT1 in oral squamous cell carcinoma

Background

Increasing evidence demonstrated the important roles of circular RNAs (circRNAs) in human cancer progression, including oral squamous cell carcinoma (OSCC). The study intentions were to explore the role and molecular mechanism of hsa_circ_0004390 (circLPAR3) in OSCC progression.

Methods

Expression of circLPAR3 in collected samples and cultured cell lines was detected with real‐time quantitative reverse transcription‐polymerase chain reaction (RT‐qPCR). Loss‐of‐function experiments were performed to determine the effect of circLPAR3 silencing on OSCC cell proliferation, migration, invasion, apoptosis, angiopoiesis, and glycolysis. The sponge function of circLPAR3 was predicted by bioinformatics analysis and validated by the dual‐luciferase reporter and RNA pull‐down assays. In vivo experiments were conducted to validate the function of circLPAR3.

Results

A marked increase in circLPAR3 expression was observed in OSCC samples and cell lines. Furthermore, circLPAR3 could distinguish OSCC samples from paired non‐tumor samples, and patients with high circLPAR3 expression had a poor prognosis. Furthermore, circLPAR3 inhibition decreased OSCC growth in xenograft mouse models. Moreover, circLPAR3 silencing repressed cell proliferation, migration, invasion, angiopoiesis, glycolysis, and induced cell apoptosis in OSCC cells in vitro. Mechanically, circLPAR3 sponged miR‐144‐3p to prohibit the inhibiting effect of miR‐144‐3p on LPCAT1, thus promoting OSCC progression.

Conclusion

CircLPAR3 exerted a tumor‐promoting effect on OSCC growth through elevating LPCAT1 expression via functioning as a miR‐144‐3p sponge. This study supports the possible role of circLPAR3 in the diagnosis, prognosis, and treatment of OSCC.

Model of an Advanced Practice Provider-Led Head and Neck Cancer Survivorship Clinic: Evaluation of a 4-Year Experience

OBJECTIVE

To report the efficacy and safety of an advanced practice provider-led head and neck cancer survivorship clinic.

STUDY DESIGN

Retrospective chart review.

SETTING

Tertiary academic medical center.

METHODS

Patients were enrolled into the survivorship clinic after undergoing 1-year follow-up with the primary head and neck surgeon. Those enrolled between December 2016 and October 2020 were retrospectively reviewed for diagnosis, staging, pattern of recurrence, visit frequency, and compliance. Surgical respectability of recurrent disease was used as a surrogate for timely diagnosis.

RESULTS

An overall 570 patients were followed within the survivorship clinic. The mean length of follow-up was 13.6 months. Mucosal primaries represented 72.6% of patients. A majority of the primary malignancies were squamous cell carcinoma (77.7%). The most common primary subsites were the oropharynx (26.7%), oral cavity (25.1%), cutaneous (17.0%), and larynx (15.3%). Recurrence was detected in 50 patients (8.8%): 26 local, 12 regional, and 14 distant. Two patients had multiple synchronous recurrences. Twelve (2.1%) second primary cancers were detected. Of the 36 cases of locoregional recurrence, 32 (88.9%) were deemed amenable to salvage surgical intervention, with or without adjuvant therapy. Negative margins were obtained in 21 of the 23 (91.3%) local recurrences that underwent salvage resection.

CONCLUSION

Advanced practice provider-based surveillance of head and neck cancer, without risk stratification, appears to be a sound model but needs further prospective evaluation. Consistent with literature, 88.9% of patients with locoregional recurrence were candidates for curative-intent salvage surgery, emphasizing that recurrences are identified in a timely fashion.

Within-patient comparison between [68Ga]Ga-tilmanocept PET/CT lymphoscintigraphy and [99mTc]Tc-tilmanocept lymphoscintigraphy for sentinel lymph node detection in oral cancer: a pilot study

PURPOSE

To compare sentinel lymph node (SLN) identification using [⁶⁸Ga]Ga-tilmanocept PET/CT lymphoscintigraphy to [^99mTc]Tc-tilmanocept lymphoscintigraphy (including SPECT/CT) in early-stage oral cancer. Furthermore, to assess whether reliable intraoperative SLN localization can be performed with a conventional portable gamma-probe using [^99mTc]Tc-tilmanocept without the interference of [⁶⁸Ga]Ga-tilmanocept in these patients.

METHODS

This prospective within-patient comparison pilot study evaluated SLN identification by [⁶⁸Ga]Ga-tilmanocept PET/CT lymphoscintigraphy compared to conventional lymphoscintigraphy using [^99mTc]Tc-tilmanocept (~ 74 MBq) in 10 early-stage oral cancer patients scheduled for SLN biopsy. After conventional [^99mTc]Tc-tilmanocept lymphoscintigraphy, patients underwent peritumoral administration of [⁶⁸Ga]Ga-tilmanocept (~ 10 MBq) followed by PET/CT acquisition initiated 15 min after injection. Intraoperative SLN localization was performed under conventional portable gamma-probe guidance the next day; the location of harvested SLNs was correlated to both lymphoscintigraphic images in each patient.

RESULTS

A total of 24 SLNs were identified by [^99mTc]Tc-tilmanocept lymphoscintigraphy, all except one were also identified by [⁶⁸Ga]Ga-tilmanocept PET/CT lymphoscintigraphy. [⁶⁸Ga]Ga-tilmanocept PET/CT lymphoscintigraphy identified 4 additional SLNs near the injection site, of which two harbored metastases. Lymphatic vessels transporting [⁶⁸Ga]Ga-tilmanocept were identified by PET/CT lymphoscintigraphy in 80% of patients, while draining lymphatic vessels were visualized by [^99mTc]Tc-tilmanocept lymphoscintigraphy in 20% of patients. Of the 33 SLNs identified by [⁶⁸Ga]Ga-tilmanocept PET/CT lymphoscintigraphy, 30 (91%) were intraoperatively localized under conventional gamma-probe guidance.

CONCLUSION

[⁶⁸Ga]Ga-tilmanocept PET/CT lymphoscintigraphy provided more accurate identification of SLNs and improved visualization of lymphatic vessels compared to [^99mTc]Tc-tilmanocept lymphoscintigraphy. When combined with peritumoral administration of [^99mTc]Tc-tilmanocept, SLNs detected by [⁶⁸Ga]Ga-tilmanocept PET/CT lymphoscintigraphy can be reliably localized during surgery under conventional gamma-probe guidance.

The Expression of Glutaminases and their Association with Clinicopathological Parameters in the Head and Neck Cancers

BACKGROUND

The increased glutamine metabolism is a characteristic feature of cancer cells. The interconversion between glutamine and glutamate is catalyzed by two glutaminase isoforms, GLS1 and GLS2, which appear to have different roles in different types of cancer. We investigated for the first time the protein expression of GLS1 and GLS2, and their correlation with advanced clinicopathological parameters in head and neck cancers.

METHOD

Consecutive slides from a tissue microarray comprised of 80 samples ranging from normal to metastatic, were stained immunohistochemically for GLS1, GLS2, HIF-1α or CD147. Following analysis by two expert pathologists we carried out statistical analysis of the scores.

RESULTS

GLS1 and GLS2 are upregulated at protein level in head and neck tumours compared to normal tissues and this increased expression correlated positively (GLS1) and negatively (GLS2) with tumor grade, indicating a shift of expression between GLS enzyme isoforms based on tumor differentiation. Increased expression of GLS1 was associated with high CD147 expression; and elevated GLS2 expression was associated with both high CD147 and high HIF-1α expressions. The correlation of the GLS1 and GLS2 with HIF-1α or CD147 was strongly associated with more advanced clinicopathological parameters.

CONCLUSION

The increased expression of GLS1 and GLS2 may be explored as a new treatment for head and neck cancers.

TERT Promoter Mutations and rs2853669 Polymorphism: Useful Markers for Clinical Outcome Stratification of Patients With Oral Cavity Squamous Cell Carcinoma

Objective

To date, no useful prognostic biomarker exists for patients with oral squamous cell carcinoma (OCSCC), a tumour with uncertain biological behaviour and subsequent unpredictable clinical course. We aim to investigate the prognostic significance of two recurrent somatic mutations (-124 C>T and -146 C>T) within the promoter of telomerase reverse transcriptase (TERT) gene and the impact of TERT single nucleotide polymorphism (SNP) rs2853669 in patients surgically treated for OCSCC.

Methods

The genetic frequencies of rs2853669, -124 C>T and -146 C>T as well as the telomere length were investigated in 144 tumours and 57 normal adjacent mucosal (AM) specimens from OCSCC patients.

Results

Forty-five tumours harboured TERT promoter mutations (31.3%), with -124 C>T and -146 C>T accounting for 64.4% and 35.6% of the alterations respectively. Patients with -124 C>T TERT promoter mutated tumours had the shortest telomeres in the AM (p=0.016) and showed higher risk of local recurrence (hazard ratio [HR]:2.75, p=0.0143), death (HR:2.71, p=0.0079) and disease progression (HR:2.71, p=0.0024) with the effect being potentiated by the co-occurrence of T/T genotype of rs2853669.

Conclusion

-124 C>T TERT promoter mutation as well as the T/T genotype of the rs2853669 SNP are attractive independent prognostic biomarkers in patients surgically treated for OCSCC, with the coexistence of these genetic variants showing a synergistic impact on the aggressiveness of the disease.

Evaluation of a streamlined sentinel lymph-node imaging protocol in early-stage oral cancer

OBJECTIVE

Sentinel lymph-node (SLN) mapping for early-stage oral squamous cell carcinoma (OSCC) is comprehensive and consequently time-consuming and costly. This study evaluated the clinical value of several SLN imaging components and analyzed the accuracy for SLN identification using a streamlined SLN imaging protocol in early-stage OSCC.

MATERIALS AND METHODS

This retrospective within-patient evaluation study compared both number and localization of identified SLNs between the conventional SLN imaging protocol and a streamlined imaging protocol (dynamic lymphoscintigraphy (LSG) for 10 min directly post-injection and SPECT-CT at ~ 2 h post-injection). LSG and SPECT-CT images of 77 early-stage OSCC patients, scheduled for SLN biopsy, were evaluated by three observers. Identified SLNs using either protocol were related to histopathological assessment of harvested SLNs, complementary neck dissection specimens and follow-up status.

RESULTS

A total of 200 SLNs were identified using the streamlined protocol, and 12 additional SLNs (n = 212) were identified with the conventional protocol in 10 patients. Of those, 9/12 were identified on early static LSG and 3/12 on late static LSG. None of the additionally identified SLNs contained metastases; none of those in whom additional SLNs were identified developed regional recurrence during follow-up. Only inferior alveolar process carcinoma showed a higher rate of additionally identified SLNs with the conventional protocol (p = 0.006).

CONCLUSION

Early dynamic LSG can be reduced to 10 min. Late static LSG may be omitted, except in those with a history of oncological neck treatment or with OSCC featuring slow lymphatic drainage. Early static LSG appeared to be contributory in most OSCC subsites.

Extracellular vesicles miR-210 as a potential biomarker for diagnosis and survival prediction of oral squamous cell carcinoma patients

Background

The identification of early diagnostic and prognostic biomarkers in oral squamous cell carcinoma (OSCC) is an unmet clinical need. We hypothesized that extracellular vesicles miR‐210 expression (EV‐miR‐210) could be a potential biomarker for OSCC diagnosis and follow‐up.

Methods

The expression of EV‐miR‐210 was measured in the plasma of OSCC patients (n = 30) and compared to that of controls (n = 14).

Results

The median EV‐miR‐210 expression was significantly higher in OSCC patients compared to controls who had often, undetectable levels (p < 0.0001). We performed receiver operating characteristic (ROC) analysis for discriminating OSCC cases from controls. EV‐miR‐210 yielded an area under the curve (AUC) of 0.9513 with sensitivity 92.3% and specificity 86.6%. Kaplan‐Meier curves indicated that high EV‐miR‐210 expression was associated with worse 3 years’ survival (p < 0.05). Cox regression hazard model indicated that high EV‐miR‐210, G2, and G3 grading and pathological nodal status (pN)>1 were independent predictors of worse survival in OSCC patients.

Conclusion

These preliminary data suggest that EV‐mir‐210 may be a novel diagnostic and prognostic biomarker in OSCC.

Extracellular ATP Induced S-Phase Cell Cycle Arrest via P2Y Receptor-Activated ERK Signaling in Poorly Differentiated Oral Squamous Cell Carcinoma SAS Cells

Extracellular ATP in the tumor microenvironment exhibits either pro- or antitumor effect via interaction with P2Y receptors, but the intracellular signaling and functional roles of P2Y receptors in oral squamous cell carcinoma (OSCC) are unclear. We aimed to study the effect of ATP on OSCC cell lines and the potential mechanisms involved. Through GEPIA dataset analysis, high expression levels of mRNA encoding P2Y receptors, the ATP-induced G protein-coupled receptors, were associated with better overall patient survival in head and neck squamous cell carcinoma. qPCR analysis showed that the poorly differentiated OSCC SAS cell line, had higher P2RY1 expression level compared to the well-differentiated H103 and H376 cell lines. Western blotting and flow cytometry analyses revealed that ATP phosphorylated ERK and elevated intracellular calcium signaling in all tested cell lines. A significant S-phase cell cycle arrest was observed in SAS, and preincubation with the MEK inhibitor PD0325901 reversed the ATP-induced S-phase arrest. We further demonstrated that ATP induced a slight reduction in cell count and colony formation yet significant apoptosis in SAS. Overall, we postulate that the ATP-induced S-phase arrest effect in SAS cells may be regulated through P2Y receptor-mediated ERK signaling, thus suggesting a potential antitumor effect of ATP via interaction with its distinct profile of P2Y receptors.

Molecular and Clinical Implications of Somatostatin Receptor Profile and Somatostatin Analogues Treatment in Oral Cavity Squamous Cell Carcinoma

Simple Summary

The treatment of oral squamous cell carcinoma (OSCC) represents a significant problem worldwide. Among cancers with the highest incidence, OSCC renders one of the worst prognoses. Therefore, novel prognostic biomarkers and therapeutic tools to tackle OSCC are urgently needed. Somatostatin-analogues (SSA) are an invaluable therapeutic option in the treatment of several cancers. We aimed to determine the expression levels of all somatostatin-receptors (SSTs) in OSCC, compared to adjacent healthy control tissues, to analyze the relationship of SSTs expression with key clinical and histopathological data, and to explore the direct in vitro effect of different SSAs on OSCC cancer cells. Our findings highlight a potential role of SST₂ as a good prognostic biomarker for recurrence and metastasis in OSCC and unveil that SSA exerts antitumoral effects on OSCC cells, providing a relevant clinical conclusion, which should be soon tested for their use in humans.

Abstract

Oral squamous cell carcinoma (OSCC) incidence has increased by 50% over the last decade. Unfortunately, surgery and adjuvant radiotherapy and chemotherapy are still the mainstream modality of treatment, underscoring the need for alternative therapies. Somatostatin-analogues (SSA) are efficacious and safe treatments for a variety of tumors, but the presence of somatostatin-receptors (SSTs) and pharmacological effects of SSA on OSCC are poorly known. In this study, we demonstrated that SST₂ and SST₃ levels were significantly higher in OSCC, compared to adjacent healthy control tissues. SST₂ expression was associated with less regional metastasis and a lower recurrence rate. Moreover, SST₂ was elevated in OSCC and associated with histopathological good prognosis factors, such as high peritumoral inflammation, smaller depth of invasion, and expansive vs. infiltrative front of tumor invasion. Importantly, treatment with different SSA (octreotide, lanreotide, and pasireotide) significantly reduced cell-proliferation in OSCC primary cell cultures. Altogether, this study demonstrated that SST₂ is overexpressed in OSCC vs. healthy tissues and could represent a novel prognostic biomarker, since its expression is associated with tumors that show better prognostic factors and less recurrent rate. Moreover, our data unveil clear antitumoral effects of SSAs on OSCC, opening new avenues to explore their potential as targeting therapy to OSCC.

Managing Recurrent Metastatic Head and Neck Cancer

Head and neck squamous cell carcinoma (HNSCC) treatment is often associated with high morbidity especially in the recurrent and/or metastatic (R/M) setting, limiting effective treatment options. Local disease control is important. Therefore, local therapies including reirradiation and salvage surgery, either alone or in combination with systemic treatment, may be used for selected patients with R/M HNSCC. Although chemotherapy and targeted agents have modest efficacy in HNSCC, the advent of immunotherapy has revolutionized the treatment paradigm of R/M HNSCC. Multiple trials have resulted in the past 5 years advocating for its use alone or in combination with chemotherapy.

Role of molecular signature to differentiate second primary lung cancer from metastasis in a patient with squamous cell carcinoma of oral cavity

Background

Lung is the most common site of distant metastasis for patients with head and neck squamous cell carcinoma (HNSCC). However, differentiating second primary lung cancers from metastasis may be difficult for p16 negative HNSCC.

Case

We describe a case of oral cavity squamous cell carcinoma (SCC) who was found to have lung nodule and hilar lymphadenopathy (LAD) after surgery and radiation therapy. Hilar node was consistent with SCC however, it was difficult to differentiate second primary lung cancer and metastasis from oral cavity SCC.

Next‐generation sequencing was done for the primary oral cavity and the hilar node. Both samples had the same type of TP53 mutation and variants of unknown significance suggesting metastatic HNSCC. He was treated with a chemotherapy regimen for metastatic HNSCC.

Conclusion

Molecular studies can help to differentiate metastasis from second primary lung cancers for p16 negative HNSCC.

Prognostic Factors Associated with Successful Salvage Surgery in Recurrent Oral Cancer

Most patients with recurrent oral cancer are not eligible for salvage surgery. Among those who are candidates for surgical salvage, failure rates are high. Given the potential negative impact of salvage surgery on quality of life (QoL)—particularly in unsuccessful interventions—the decision to operate must be weighed carefully. However, the variables associated with successful surgical salvage in oral cancer have not been clearly established. In the present retrospective study, we sought to determine the factors associated with disease recurrence and successful salvage surgery. We evaluated the following parameters in patients (n = 261) treated for primary oral cancer at our institution from 2010 to 2017: age; T/N status; perineurial invasion; lymphovascular invasion; extranodal extension; and margin status. In total, 36 patients (33%) were considered eligible for salvage surgery. Four variables were significantly associated with suitability for salvage surgery: early primary T stage, no primary neck disease (N0), no positive margins in the primary resection, and no adjuvant radiotherapy following primary resection. The only variable significantly associated with improved salvage outcomes was negative margin status after the primary tumor resection, underscoring the importance of margin status on treatment outcomes. Additional studies are needed to identify other factors associated with successful salvage surgery in order to better stratify patients according to the likelihood of success, thus potentially avoiding the negative impact on QoL in patients who undergo unsuccessful surgery.

TNM 8 staging is a better prognosticator than TNM 7 for patients with locally advanced oral cavity squamous cell carcinoma treated with surgery and post-operative radiotherapy

PURPOSE

To assess TNM 8 staging in discriminating overall survival (OS) amongst patients with locally advanced oral cavity squamous cell carcinoma (OCSCC) treated with surgery and post-operative radiotherapy (PORT), compared to TNM 7.

MATERIAL AND METHODS

Data from OCSCC patients treated with surgery and PORT between January 2010 and December 2018 were reviewed. Demographics, tumour characteristics and treatment response data were collected, and patients staged according to both TNM 7 and TNM 8. OS and disease free survival (DFS) were estimated using the Kaplan Meier method. Univariate and multivariable analyses were conducted for factors affecting OS, DFS and early disease recurrence within 12 months.

RESULTS

Overall 172 patients were analyzed. Median follow up was 32 months for all patients and 48 months for surviving patients. TNM 8 staging demonstrated significant stratification of OS and DFS amongst the entire cohort, whereas TNM 7 staging did not. On multivariable analysis, TNM 8 stage, performance status (PS) and a positive surgical margin were prognostic for OS. Looking at disease recurrence within 12 months, TNM 8 stage IVB, presence of lymphovascular invasion (LVSI), younger age and lesser smoking history were predictive factors on multivariable analysis.

CONCLUSION

TNM 8 is a good development of its predecessor in terms of predicting survival for patients with locally advanced OCSCC. We have also identified younger age (<60 years) and a smoking history of <10 pack years as risk factors for early disease recurrence, potentially representing a separate biological cohort within OCSCC patients.

Second primary tumours after squamous cell carcinoma of the oral cavity

INTRODUCTION

The aim of this study was to determine the incidence, location and timing of second primary tumours (SPT) after diagnosis of oral squamous cell carcinoma (OSCC) and relate the risk of SPT to that after head and neck squamous cell carcinoma (HNSCC) and the risks of those tumours in the general population in order to assess the need for a separate follow-up programme for OSCC patients and to aid development of an evidence-based and individualized follow-up programme for OSCC patients.

MATERIALS AND METHODS

All patients diagnosed with OSCC or HNSCC in the Netherlands in 1991-2015 were selected from the Netherlands Cancer Registry. Cumulative incidence rates and Standardized Incidence Ratios (SIR) were calculated. Analyses were stratified by incidence period and age at primary diagnosis of the index tumour, follow-up time, and site of the SPT.

RESULTS

We included 11263 patients with OSCC from a population of 34244 patients with HNSCC, of which the median follow-up time was 4.0 years. OSCC SPT develop in different patterns and at different locations than after HNSCC. The 5-year risk of SPT and SIR (95% confidence intervals) were respectively 0.13 (0.13-0.14) and 3.0 (2.9-3.1) for OSCC. The risk of a SPT was continuous over follow-up time and calendar period but decreased with an increasing age at diagnosis of the index tumour up to the age of 75 and there were differences in sites of SPT.

CONCLUSION

A specific follow-up protocol for OSCC is needed, which can be individualized on the basis of, among others, age.

A cause-specific Cox model for second primary tumors in patients with head and neck cancer: A RONCDOC study

Background

The aim of this study was to identify risk factors for the development of second primary tumors (SPTs) in the head and neck region, lungs, and esophagus in patients with head and neck cancer.

Methods

We collected data from 1581 patients. A cause‐specific Cox model for the development of an SPT was fitted, accounting for the competing risks residual/recurrent tumor and mortality.

Results

Of all patients, 246 (15.6%) developed SPTs. Analysis showed that tobacco and alcohol use, comorbidity, and the oral cavity subsite were risk factors for SPTs. The C‐index, the discriminative accuracy, of the model for SPT was 0.65 (95% confidence interval, 0.61–0.68).

Conclusions

Our results show that there is potential to identify patients who have an increased risk to develop an SPT. This might increase their survival chances and quality of life. More research is needed to provide head and neck clinicians with definitive recommendations.

Follow-up after oral cancer treatment-Transition to a personalized approach

BACKGROUND

Guidelines for follow-up after oral cancer treatment are not site-specific and encompass the entire head and neck area rather than the oral cavity alone. This one-size-fits-all protocol disregards the differences in aetiology, treatment and differential distribution of new disease between the subsites. With the effectiveness of follow-up in early detection of new disease being put into question, the focus of follow-up programmes might shift to other aspects of survivorship care. Personalization of follow-up is important, considering patient-specific features and needs. Furthermore, the COVID-19 pandemic urges us to rethink our follow-up practice.

FINDINGS

This paper discusses ways in which routine follow-up in patients treated for oral cancer can be optimized. Patients with a high risk of new disease might benefit from an intensified follow-up regimen, whilst patients with a low risk of new disease, a low chance of cure or limited life expectancy could benefit from a de-intensified follow-up regimen. The latter could include a shorter follow-up period and focus on goals other than early detection of new disease. Education of patients to report new symptoms early is of vital importance as the majority of new disease presents symptomatically. Other health care professionals such as specialist nurses and dentists need to play an important leading role in survivorship care. Remote consultations may be useful to perform more efficient and patient-centred follow-up care.

CONCLUSION

Routine follow-up needs to be seen as an integrated part of an individualized survivorship plan that is provided by the entire multidisciplinary team.

Preclinical Assessment of the Effectiveness of Magnetic Resonance Molecular Imaging of Extradomain-B Fibronectin for Detection and Characterization of Oral Cancer

PURPOSE

Oral squamous cell carcinoma (OSCC) has not seen a substantial improvement in patient survival despite therapeutic advances, making accurate detection and characterization of the disease a clinical priority. Here, we aim to demonstrate the effectiveness of magnetic resonance imaging (MRI) with the targeted MRI contrast agent MT218 specific to extradomain-B fibronectin (EDB-FN) in the tumor microenvironment for detection and characterization of aggressive OSCC tumors.

PROCEDURES

EDB-FN expression was evaluated in human normal tongue and OSCC specimens with immunohistochemistry. Invasiveness of human CAL27, HSC3, and SCC4 OSCC cells was analyzed with spheroid formation and transwell assays. EDB-FN expression in the cells was analyzed with semiquantitative real-time PCR, western blotting, and a peptide binding study with confocal microscopy. Contrast-enhanced MRI with MT218 was performed on subcutaneous OSCC mouse models at a dose of 0.04 mmol/kg, using gadoteridol (0.1 mmol/kg) as a control.

RESULTS

Strong EDB-FN expression was observed in human untreated primary and metastatic OSCC, reduced expression in treated OSCC, and little expression in normal tongue tissue. SCC4 and HSC3 cell lines demonstrated high invasive potential with high and moderate-EDB-FN expression, respectively, while CAL27 showed little invasive potential and low-EDB-FN expression. In T₁-weighted MRI, MT218 produced differential contrast enhancement in the subcutaneous tumor models in correlation with EDB-FN expression in the cancer cells. Enhancement in the high-EDB-FN tumors was greater with MT218 at 0.04 mmol/kg than gadoteridol at 0.1 mmol/kg.

CONCLUSIONS

The results suggest EDB-FN has strong potential as an imageable biomarker for aggressive OSCC. MRMI results demonstrate the effectiveness of MT218 and the potential for differential diagnostic imaging of oral cancer for improving the management of the disease.

Follow-Up of Head and Neck Cancer Survivors: Tipping the Balance of Intensity

The traditional concept of post-treatment surveillance in head and neck cancer patients relies on examinations directed at early detection of disease recurrence and/or second primary tumors. They are usually provided by ear, nose and throat specialists with complementary input from radiation oncologists and medical oncologists. Emerging evidence underscores the importance of monitoring and effective management of late adverse events. One of the major drawbacks is a lack of prospective controlled data. As a result, local institutional policies differ, and practice recommendations are subject to continuing debate. Due to the economic burden and impact on emotional comfort of patients, intensity and content of follow-up visits are a particularly conflicting topic. According to the current evidence-based medicine, follow-up of head and neck cancer patients does not prolong survival but can improve quality of life. Therefore, an approach giving priority to a multidisciplinary care involving a speech and swallowing expert, dietician, dentist, and psychologist may indeed be more relevant. Moreover, on a case-by-case basis, some patients need more frequent consultations supplemented by imaging modalities. Human papillomavirus positive oropharyngeal cancer tends to develop late failures at distant sites, and asymptomatic oligometastatic disease, especially in the lungs, can be successfully salvaged by local ablation, either surgically or by radiation. The deep structures of the skull base related to the nasopharynx are inaccessible to routine clinical examination, advocating periodic imaging supplemented by nasofibroscopy as indicated. Anamnesis of heavy smoking justifies annual low-dose computed tomography screening of the thorax and intensive smoking cessation counseling. Finally, some cancer survivors feel more comfortable with regular imaging, and their voice should be taken into consideration. Future development of surveillance strategies will depend on several variables including identification of reliable predictive factors to select those who could derive the most benefit from follow-up visits, the availability of long-term follow-up data, the results of the first randomized trials, resource allocation patterns, infrastructure density, and the therapeutic landscape of locally advanced and recurrent and/or metastatic disease, which is rapidly changing with the advent of immune checkpoint inhibitors and better utilization of local approaches.

Point-of-care oral cytology tool for the screening and assessment of potentially malignant oral lesions

BACKGROUND

The effective detection and monitoring of potentially malignant oral lesions (PMOL) are critical to identifying early-stage cancer and improving outcomes. In the current study, the authors described cytopathology tools, including machine learning algorithms, clinical algorithms, and test reports developed to assist pathologists and clinicians with PMOL evaluation.

METHODS

Data were acquired from a multisite clinical validation study of 999 subjects with PMOLs and oral squamous cell carcinoma (OSCC) using a cytology-on-a-chip approach. A machine learning model was trained to recognize and quantify the distributions of 4 cell phenotypes. A least absolute shrinkage and selection operator (lasso) logistic regression model was trained to distinguish PMOLs and cancer across a spectrum of histopathologic diagnoses ranging from benign, to increasing grades of oral epithelial dysplasia (OED), to OSCC using demographics, lesion characteristics, and cell phenotypes. Cytopathology software was developed to assist pathologists in reviewing brush cytology test results, including high-content cell analyses, data visualization tools, and results reporting.

RESULTS

Cell phenotypes were determined accurately through an automated cytological assay and machine learning approach (99.3% accuracy). Significant differences in cell phenotype distributions across diagnostic categories were found in 3 phenotypes (type 1 ["mature squamous"], type 2 ["small round"], and type 3 ["leukocytes"]). The clinical algorithms resulted in acceptable performance characteristics (area under the curve of 0.81 for benign vs mild dysplasia and 0.95 for benign vs malignancy).

CONCLUSIONS

These new cytopathology tools represent a practical solution for rapid PMOL assessment, with the potential to facilitate screening and longitudinal monitoring in primary, secondary, and tertiary clinical care settings.

Time patterns of recurrence and second primary tumors in a large cohort of patients treated for oral cavity cancer

INTRODUCTION

Routine follow-up after curative treatment of patients with oral squamous cell carcinoma (OSCC) is common practice considering the high risk of second primaries and recurrences (ie second events). Current guidelines advocate a follow-up period of at least 5 years. The recommendations are not evidence-based and benefits are unclear. This is even more so for follow-up after a second event. To facilitate the development of an evidence- and personalized follow-up program for OSCC, we investigated the course of time until the second and subsequent events and studied the risk factors related to these events.

MATERIALS AND METHODS

We retrospectively studied 594 OSCC patients treated with curative intent at the Head and Neck Cancer Unit of the Radboud University Medical Centre from 2000 to 2012. Risk of recurrence was calculated addressing death from intercurrent diseases as competing event.

RESULTS

The 1-, 5- and 10-year cumulative risks of a second event were 17% (95% CI:14%;20%), 30% (95% CI:26%;33%), and 37% (95% CI:32%;41%). Almost all locoregional recurrences occurred in the first 2 years after treatment. The incidence of second primary tumors was relatively stable over the years. The time pattern of presentation of third events was similar.

DISCUSSION

Our findings support a follow-up time of 2 years after curative treatment for OSCC. Based on the risk of recurrence there is no indication for a different follow-up protocol after first and second events. After 2 years, follow-up should be tailored to the individual needs of patients for supportive care, and monitoring of late side-effects of treatment.