Changing epidemiology of oral squamous cell carcinoma of the tongue: A global study

Cellular morphometry of the neoplastic microenvironment and its association with the immunoexpression of interleukin-4

The objective of this research is to perform a cellular morphometric analysis, identify nuclear malignant keratinocyte irregularities, compare the immunoexpression of interleukin-4 (IL-4) and investigate neoplastic invasion depth in Lower Lip Squamous Cell Carcinoma (LLSCC) and Oral Tongue Squamous Cell Carcinoma (OTSCC) cases. A total of 60 cases were analyzed (30 on the lower lip and 30 on the oral tongue). Concerning the cellular morphometry analysis, 16 malignant keratinocytes from each case were analyzed. IL-4 immunoexpression was analyzed in the parenchyma and stroma of the investigated lesions, in both deep and superficial fields, employing an image analysis software. ANOVA and Spearman's correlation statistical tests were applied. Total IL-4 immunoexpression was higher in LLSCC cases in all analyzed fields (p: 0.007); Positive correlation between the cellular perimeter of malignant keratinocytes in the superficial fields and lesion invasion depth was observed (p: 0.009), as well as between the total cellular area and neoplastic invasion depth (p: 0.038). A negative correlation, on the other hand, was observed between superficial lesion parenchyma IL-4 immunoexpression and nuclear perimeter in superficial fields (p: 0.007), as well as between total deep stroma IL-4 immunoexpression and neoplastic invasion depth (p: 0.008). These findings suggest that SCC displaying greater neoplastic invasion depth exhibit greater nuclear and cellular morphology alterations, albeit reducing IL-4 expression, potentially due to loss of the differentiated cell phenotype.

ISG15 depletion enhances oHSV-1 replication and antitumor efficacy in oral squamous cell carcinoma

Oncolytic viruses (OVs) represent a promising experimental therapy for a range of cancers, including oral squamous cell carcinoma (OSCC). In this study, oHSV refers to an oncolytic virus engineered from HSV-1(Herpes Simplex Virus Type 1). The oHSV-1 is an oncolytic virus derived from HSV-1, where both copies of the ICP34.5 coding sequences have been replaced with the EGFP gene, and the ICP47 gene has been deleted. In previous studies, resistance was observed in certain SCC15 xenograft models treated with oncolytic herpes simplex viruses (oHSV-1). Primary tumor cells were extracted from these resistant models, followed by RNA sequencing with SCC15 cells as controls. Analysis revealed that ISG15 expression was upregulated in the resistant primary cells, as well as in HSV-infected breast cancer cells (GSE137757). In this study, we confirmed that knockdown ISG15 in SCC15 cells enhanced oHSV-1 replication, while ISG15 overexpression suppressed it. Mechanistic studies demonstrated that ISG15 inhibits oHSV-1 replication via ISGylation. To improve the therapeutic efficacy of oHSV-1, an oHSV-1 variant expressing ISG15-targeting short hairpin RNA (shRNA), termed oHSV-1-shISG15, was engineered. oHSV-1-shISG15 exhibited enhanced antitumor efficacy compared to oHSV-1 in vitro and in vivo. These findings suggest that ISG15 depletion augments oHSV-1 replication in OSCC tumor cells through ISGylation inhibition. Meanwhile, this study provides a novel recombinant oncolytic virus to potentiate the efficacy of oncolytic herpes virotherapy.

Histological and Clinical Characteristics of Oral Squamous Cell Carcinoma Analyzed by Digitally Assembled Whole-Mount Sections

BACKGROUND

The diagnosis of oral squamous cell carcinoma (OSqCC) is sometimes delayed. In this study, we attempted to comprehensively analyze the surface and cross section of OSqCC using whole-mount sections.

METHODS

Representative cross sections of 41 pT2 and pT3 OSqCC were digitally assembled, and whole-mount sections were reconstructed. In the cross section of the tumor, the degree of differentiation was classified as well/moderately differentiated (WDMD) and poorly differentiated (PD); and the surface of the specimen was divided into four types: benign-looking epithelium, dysplasia, carcinoma, and ulceration.

RESULTS

In the cross-sectional analysis, 17 cases (41.5%) consisted of only WDMD, and the PD component was predominant in seven cases (17.1%). In the remaining 17 patients, the PD component was partial (< 50%). When grouping noncancerous lesions (benign-looking epithelium and dysplasia, BnDy) and cancerous lesions (carcinoma and ulceration, CaUl) in the surface analysis, the proportion of CaUl was significantly lower in the tongue than in other oral sites (p = 0.009) In the survival analysis, although not statistically significant, the overall survival of partial PD patients was more similar to that of the predominant PD group compared to that of the WDMD-only group.

Examining the Impact of Race and Sex on the Incidence of Positive Surgical Margins in Oral Cavity Squamous Cell Carcinoma

OBJECTIVE

The aim of this study was to compare the incidence of positive surgical margins (PSMs) between different races and sexes in a national cohort.

MATERIALS AND METHODS

In this study, we analyzed the association between race and sex disparities and the incidence of PSMs based on data from the 2004-2016 National Cancer Database (NCDB). The NCDB includes deidentified data collected from over 1500 hospitals as part of the Commission on Cancer approvals program and represents over 70% of new cancer cases in the United States. This analysis provides minimally adjusted and further adjusted multivariate analyses of the incidence of positive surgical margins in OCSCC stratified by sex and race, disease characteristics, other demographics, comorbidities, and social determinants of health (SDOH).

RESULTS

The incidence of PSMs was found to be elevated in black males of any age, black males under the age of 45, and in Indigenous American and native Alaskan males under the age of 45, independent of clinicopathologic factors. Specifically, black patients had a significantly higher incidence of PSMs when controlling for age, subsite, stage, grade, LVI, and CDCS. Our results remained unchanged after adjusting for the SDOH variables of insurance coverage, level of education, income, metropolitan versus urban versus rural location, distance from treatment center, and facility type.

CONCLUSION

The findings of this study suggest that black males of any age, black males under 45, and Indigenous American and native Alaskan males under 45 have a higher incidence of PSMs, independent of clinicopathologic factors and SDOH. Our findings may help inform clinicians and hospitals of lapses in our healthcare system that perpetuate these inequities and further the goal of tackling disparities in surgical care.

High Sugar-Sweetened Beverage Intake and Oral Cavity Cancer in Smoking and Nonsmoking Women

Importance

The incidence of oral cavity cancer (OCC) is increasing among nonsmokers and young individuals without traditional risk factors worldwide. High sugar-sweetened beverage (SSB) intake is associated with various gastrointestinal cancers, but its association with OCC has not been explored.

Objective

To evaluate the association between SSB intake and the risk of OCC among smoking and nonsmoking women participating in the Nurses' Health Study (NHS) and Nurses' Health Study II (NHSII).

Design, Setting, and Participants

This longitudinal cohort study analyzed data from women in the NHS (follow-up, 1986-2016) and NHSII (follow-up, 1991-2017) after excluding those with a history of cancer, implausible caloric intake, or missing SSB intake data. Participants were followed up until the diagnosis of OCC. Data analysis was performed from July 2023 to June 2024.

Exposure

SSB intake, quantified by frequency of consumption ranging from less than 1 SSB monthly to 1 or more SSBs daily.

Main Outcome and Measure

Cox proportional hazards regression models with age and questionnaire period as the time scale were used to estimate hazard ratios (HRs) and 95% CIs associated with the development of OCC for each category of SSB intake, with less than 1 SSB per month as the reference group.

Results

A total of 162 602 women (mean [SD] age, 43.0 [9.9] years) were evaluated. During 30 years of follow-up, 124 invasive OCC cases were documented. In multivariable-adjusted models, participants consuming 1 or more SSB daily (5 people per 100 000 population) had a 4.87 times (95% CI, 2.47-9.60 times) higher risk of OCC compared with those consuming less than 1 SSB monthly (2 people per 100 000 population), increasing the rate of OCC to 3 more people per 100 000 population. When restricted to both nonsmokers or light smokers and nondrinkers or light drinkers, the risk of OCC was 5.46 times (95% CI, 1.75-17.07 times) higher, increasing the rate of OCC to 3 more people per 100 000 population.

Conclusions and Relevance

In this study, high SSB intake was associated with a significantly increased risk of OCC in women, regardless of smoking or drinking habits, yet with low baseline risk. Additional studies are needed in larger cohorts, including males, to validate the impact of these findings.

KIF2C promotes oral squamous cell carcinoma progression via PLK1 upregulation: implications for biomarker development and therapeutic targeting

Oral squamous cell carcinoma (OSCC) is a highly aggressive malignancy with poor prognosis due to late detection, rapid progression, and frequent metastasis, underscoring the urgent need for novel therapeutic targets. This study investigates the roles of kinesin family member 2C (KIF2C) and Polo-like kinase 1 (PLK1) in OSCC progression and their functional interplay. Immunohistochemical and western blot analyses revealed marked upregulation of KIF2C and PLK1 in human OSCC tissues and cell lines (SCC9, SCC25, Cal27). Functional characterization in Cal27 cells (selected for highest KIF2C expression via qPCR/WB) demonstrated that KIF2C knockdown via siRNA transfection suppressed proliferation, migration, invasion, and epithelial-mesenchymal transition (EMT), while inducing apoptosis and G0/G1 cell cycle arrest. Mechanistically, KIF2C silencing downregulated PLK1 expression, concomitantly reducing EMT markers (N-cadherin, vimentin), matrix metalloproteinases (MMP-2/9), and angiogenesis factors (VEGF, α-SMA). Complementary assays (CCK-8, EdU, Transwell, wound healing) and flow cytometry confirmed that KIF2C-PLK1 axis promotes tumor growth by enhancing matrix degradation, angiogenesis, and S-phase proliferation while inhibiting apoptosis. These findings establish KIF2C as a pivotal regulator of OSCC progression through PLK1-mediated signaling, highlighting their dual potential as prognostic biomarkers and therapeutic targets for OSCC management.

Immunoexpression of CXCL12 and CXCR4 in oral tongue squamous cell carcinoma of young and older patients

PURPOSE

This study analyzed the immunoexpression of C-X-C chemokine ligand 12 (CXCL12) and C-X-C chemokine receptor 4 (CXCR4) in oral tongue squamous cell carcinoma (OTSCC) of young (≤ 45 years) and older (≥ 60 years) patients and correlated the findings with clinicopathological parameters (sex, tumor size, regional metastasis, clinical stage, and histopathological grade of malignancy).

METHODS

Forty OTSCC cases (20 diagnosed in young patients and 20 diagnosed in older patients) were selected. Cytoplasmic (CXCL12 and CXCR4) and nuclear (CXCR4) staining percentages in epithelial and stromal cells were assessed at the invasive tumor front.

RESULTS

Low median percentages of CXCL12 positivity were observed in epithelial and stromal cells of OTSCC in both age groups. In stromal cells, expression of this chemokine was higher in older individuals compared to young individuals (p = 0.026). Expression of CXCR4 in neoplastic cells was more frequent in older individuals, with higher median percentages of cytoplasmic (p = 0.023) and nuclear (p = 0.001) positivity compared to young individuals. In stromal cells, older individuals exhibited a significantly higher cytoplasmic expression of CXCR4 (p < 0.001). No significant differences in CXCL12 or CXCR4 immunoexpression according to clinicopathological parameters was observed in either age group (p > 0.05). Positive correlations between cytoplasmic and nuclear expressions of CXCR4 were found in young (r = 0.580; p = 0.007) and older individuals (r = 0.476;p = 0.034).

CONCLUSION

The results suggest the participation of CXCR4 in the development of OTSCC, especially in older individuals. The findings also support possible age-related differences in the pathogenesis of this malignant neoplasm. Nevertheless, this protein may not be involved in the progression of OTSCC.

Targeting CD276: a promising strategy for CAR-NK cell immunotherapy in human oral tongue squamous cell carcinoma

Human oral tongue squamous cell carcinoma (OTSCC) is a prevalent form of head and neck squamous cell carcinoma (HNSCC), often presenting at an advanced stage with a grim prognosis. Traditional therapeutic approaches such as surgery, adjuvant radiotherapy, and chemoradiotherapy have shown limited efficacy in treating advanced OTSCC, underscoring the urgent need for innovative treatment strategies. Our bioinformatics analysis identified CD276 as a significant biomarker in OTSCC, with high protein expression levels correlating to a markedly reduced survival rate in late-stage patients. This discovery has led us to develop chimeric antigen receptor-natural killer (CAR-NK) cells derived from umbilical cord blood cells (UCBCs), specifically targeting CD276. Our aim is to investigate this novel therapeutic approach for its potential to combat OTSCC under pre-clinical conditions. Our in vitro and ex vivo studies have demonstrated that CD276-targeted CAR-NK cells exhibit remarkable efficacy in lysing OTSCC cell lines and primary cells, as well as in eliminating OTSCC organoids. These promising results underscore the pivotal role of CD276 in OTSCC pathogenesis and highlight the potential of CAR-NK cell therapy as a groundbreaking treatment option for advanced-stage OTSCC, offering new hope for translational medicine in the field of stomatology.

Pretreatment Pain as a Prognostic Predictor in Oral Tongue Squamous Cell Carcinoma: The Mediating Role of Perineural Invasion

BACKGROUND

The potential effects of pretreatment pain on prognosis of tongue squamous cell carcinoma (TSCC) and the role that perineural invasion (PNI) plays in this process remains unclear.

PURPOSE

The purposes of this study are to estimate the prognostic value of pretreatment pain and identify whether PNI is a mediating factor in the relationship between pretreatment pain and prognosis in TSCC.

STUDY DESIGN, SETTING, SAMPLE

This retrospective cohort study included TSCC patients who underwent first resections of primary lesions at the Beijing Stomatological Hospital of Capital Medical University between January 2009 and December 2019. Patients who had incomplete medical records and pathological data, received neoadjuvant radiotherapy and chemotherapy before surgery, and did not receive a TSCC diagnosis, were excluded.

PREDICTOR VARIABLE

The predictor variables are pretreatment pain and PNI. The visual analog scale (VAS) was used to assess pretreatment pain levels, and the PNI status was evaluated by pathological section.

MAIN OUTCOME VARIABLE(S)

The main outcome variables were the 3-year disease-specific survival (DSS) and disease-free survival (DFS).

COVARIATES

Covariates included age, sex, smoking history, alcohol history, growth pattern, and T-stage.

ANALYSES

The χ2 test was used to describe the baseline data. Kaplan-Meier analysis was used to estimate the 3-year DSS and DFS. The Cox regression model was adapted for univariate and multivariate analysis. The association between VAS score and PNI was analyzed using logistic regression analysis and mediation analysis. P value less than .05 indicated statistical significance.

RESULTS

The study included 307 subjects with a mean age of 52 (±12.1) years, and 164 (53.4%) were male. There were 65 (21.2%) with high VAS (>5) and 242 (78.8%) with low VAS (≤5). The DSS and DFS of high VAS were 64.6% (95% CI: 23.6 to 80.9%) and 52.3% (95% CI: 35.3 to 92.8%), of patients with PNI were 62.7% (95% CI: 19.6 to 64.5%) and 46.7% (95% CI: 25.9 to 66.9%), respectively. The group high VAS/with PNI had lower DSS and DFS than group high VAS/without PNI (55.3 and 40.4% vs 88.9 and 83.3%). The VAS and PNI were identified as independent factors associated with prognosis (P < .05). Mediation analysis revealed that the indirect effect of VAS on DFS was 0.071 (95% CI: 0.011 to 0.135, P = .024), while the total effect was 0.187 (95% CI: 0.074 to 0.296, P < .001), VAS score affected the DFS of TSCC through the mediating effect of PNI.

CONCLUSION AND RELEVANCE

Our findings confirmed that pretreatment pain is associated with worse outcomes in TSCC. Patients with TSCC and severe pretreatment pain are more likely to be diagnosed with PNI, which results in a worse prognosis.

Risk factors and incidence of oral tumors: Findings from a longitudinal population-based study

OBJECTIVE

This study investigated risk factors contributed to benign and malignant oral tumors using longitudinal cohort big data.

MATERIALS AND METHODS

We included individuals aged ≥40 years who participated in the National Health Examination in South Korea between 2003 and 2004. National Health Insurance claims data after 16 years were used to determine the incidence of oral tumors and the related risk factors. Hazard ratios were calculated using the Cox proportional hazard regression.

RESULTS

A total of 5,992,671 participants were included. The incidence of oral cancer was significantly higher in men and increased with age, whereas that of benign tumors was unaffected by sex and decreased with age. Periodontal disease was associated with the incidence of oral cancer but not benign tumors. Soft tissue diseases were associated with both benign and malignant tumors. Various systemic diseases influence the development of oral tumors. Light alcohol consumption reduced the incidence of oral tumors, whereas heavy alcohol consumption increased the incidence of malignant tumors only. Smoking increased the incidence of benign but not malignant tumors.

CONCLUSION

Recognized risk factors such as sex, age, comorbidities, and dental diseases were associated with oral tumors. Alcohol consumption and smoking were not significantly associated with malignant tumors.

Unique clinical features and prognostic risk factors of oral squamous cell carcinoma in patients under 30 years old

BACKGROUND

Individuals under 30 years old with oral squamous cell carcinoma (OSCC) are a relatively rare subgroup but require attention. However, literature on the clinicopathological characteristics of OSCC patients under 30 is currently lacking.

METHODS

A total of 66 OSCC patients under 30 were included in this study. We collected data on demographic characteristics, chief complaint, risk factors, pathological features, imaging, blood test, staging, neoadjuvant therapy, surgical treatment plans, and survival status. Survival curves for overall survival (OS) and disease-free survival (DFS) were generated to explore prognostic factors in patients under 30.

RESULTS

Among the 66 patients, tongue cancer was predominant, accounting for 60/66 (90.9%). Female patients had no history of smoking, alcohol consumption, or betel nut chewing, whereas all male patients with a history of betel nut chewing were smokers. Patients who sought medical attention shortly after the onset of symptoms tended to demonstrate greater disease severity. The 5-year OS for these patients was 88.9%, and the 5-year DFS was 77.2%. Smoking, drinking, betel nut chewing, staging, LNM, and tumor histological differentiation were not associated with OS and DFS, whereas high neutrophil count and high monocyte count were associated with better survival outcomes.

CONCLUSION

Our study dataset shows that OSCC patients under 30 are a subgroup with a high prevalence of tongue cancer, distinct etiological factors in females, and increasing proportions of betel nut chewing and moderately/poorly differentiated tumors. This subgroup generally has a favorable prognosis, but the prognostic factors differ from those in the general OSCC population.

Factors influencing the ability of health professionals to manage of tracheal intubation and tracheal extubation in oral and maxillofacial malignancies patients following surgery: a qualitative study

PURPOSE

This study aimed to explore factors that hinder the effective management of tracheal intubation and tracheal extubation by healthcare professionals (HCPs) in patients with oral and maxillofacial malignancies (OMMs) following surgery in the intensive care unit (ICU).

METHODS

A phenomenological approach was used in this qualitative study. Data were collected using semi-structured, face to face, in-depth interviews with 12 experienced HCPs in three clinical units at a tertiary hospital in Shanghai, China, from February to May 2024. Purposive sampling was used. The data were organized and analyzed using NVivo 12.0 software and Braun and Clarke's reflective thematic analysis.

RESULTS

Twelve HCPs had a mean age of 39.92 years (SD 6.76); n = 7 (58.33%) were nurses. Two themes and seven sub-themes emerged: (1) institutional factors: lack of a risk assessment system for airway obstruction, lack of a tracheal intubation emergency team, inconsistent preparations for delayed extubation, and inadequate reintubation training for airway obstruction, and (2) individual factors: normativity of airway humidification, knowledge of the risk of airway obstruction, and attitude related to learning about airway obstruction.

CONCLUSION

The inadequate management of tracheal intubation and tracheal extubation by HCPs in OMMs patient after surgery is influenced by multiple factors. Designing targeted interventions utilizing these influencing factors will improve the ability of HCPs to manage tracheal intubation and tracheal extubation and ensure the life safety and effective treatment of OMMs patients following surgery.

PER3 suppresses tumor metastasis of oral squamous cell carcinoma by promoting HIF-1α degradation

The low expression of period circadian regulator 3 (PER3) in head and neck squamous cell carcinoma is closely correlated with tumor size and invasion depth. Hypoxia-inducible factor 1 subunit alpha (HIF-1α) regulates epithelial-mesenchymal transition (EMT) transcription factors, activates EMT, and promotes tumor metastasis. Here, we investigated the role and molecular mechanism of PER3 in regulating HIF-1α and metastasis in oral squamous cell carcinoma (OSCC) by using bioinformatics analyses and in vitro and in vivo experiments. PER3 expression was decreased in OSCC, and PER3 expression was significantly negatively correlated with T stage, N stage, clinical classification, and survival time. PER3 overexpression inhibited, while PER3 knockdown prompted EMT and metastasis of OSCC cells. HIF-1α reversed the effects of alterations in PER3 expression on OSCC metastasis. Mechanistically, PER3 bound to HIF-1α via the Per-ARNT-Sim 1 domain and promoted its ubiquitination degradation. Hypermethylation at CpG site cg12258811 of PER3 promoter inhibited PER3 expression and prognosis of OSCC. Decitabine combined with LW6 upregulated PER3, downregulated HIF-1α, and inhibited lymph node metastasis of OSCC in nude mice. Our findings reveal the role and mechanism of HIF-1α regulation by PER3 and support the potential clinical application of targeting PER3 in treating OSCC metastasis.

Heterogeneity analysis and prognostic model construction of HPV negative oral squamous cell carcinoma T cells using ScRNA-seq and bulk-RNA analysis

BACKGROUND

T cells are involved in every stage of tumor development and significantly influence the tumor microenvironment (TME). Our objective was to assess T-cell marker gene expression profiles, develop a predictive risk model for human papilloma virus (HPV)-negative oral squamous cell carcinoma (OSCC) utilizing these genes, and examine the correlation between the risk score and the immunotherapy response.

METHODS

We acquired scRNA-seq data for HPV-negative OSCC from the GEO datasets. We performed cell‒cell communication, trajectory, and pathway enrichment analyses of T-cell-associated genes. In addition, we constructed and validated a T-cell-associated gene prognostic model for HPV-negative OSCC patients using TCGA and GEO data and assessed the immune infiltration status of HPV-negative OSCC patients .qRT-PCR was used to detect the expression level of prognosis-related genes in different risk groups.

RESULTS

ScRNA-seq was conducted on 28,000 cells derived from 14 HPV-negative OSCC samples and 6 normal samples. We identified 4,635 T cells from these cells and identified 774 differentially expressed genes(DEGs) associated with T cells across five distinct T-cell subtypes. Through the integration of bulk-RNAseq data, we established a prognostic model based on DEGs related to T cells. By separating patients into high-risk and low-risk groups according to these prognostic related genes, we can accurately predict their survival rates and the immune infiltration status of the TME.qRT-PCR results showed that compared with the patients of low risk group, the expression of PMEPA1, SH2D2A, SMS and PRDX4 were significantly up-regulated in high risk group.

CONCLUSION

This study provides a resource for understanding the heterogeneity of T cells in HPV-negative OSCC patients and associated prognostic risk models. It provides new insights for predicting survival and level of immune infiltration in patients with HPV-negative OSCC.

Non-smoking, non-drinking, oral squamous cell carcinoma patients are a distinct and clinically significant group

PURPOSE

Carcinogenesis of oral squamous cell carcinoma (OSCC) has long been associated with exposure to tobacco smoke and alcohol consumption. Some centres have reported that non-smoking non-drinking (NSND) patients represent a significant and increasing proportion of OSCC cases with reports of poorer outcomes. Demographic characteristics are variably reported for this group and carcinogenesis is not fully understood. We present the largest cohort study to date in this subject area and sought to better understand demographics and survival.

METHODS

We interrogated 541 OSCC patients by retrospective analysis to assess risk factor status, disease characteristics and survival. Patients were categorised according to smoking and alcohol exposure with non-smoker (NS) status defined as less than five cigarettes per week with no history of use greater than this. Non-drinker (ND) status was defined as less than three standard drinks per week with no history of alcohol consumption greater than this. Those both NS and ND were categorised as NSND. Subsite, tumour stage and treatment were recorded along with evidence of cervical nodal and distant metastasis.

RESULTS

These patients were more likely to be female, older and present with early-stage disease. Tumour site was tongue, maxillary alveolus and buccal mucosa, at variance with the smoker drinker groups.

CONCLUSION

NSNDs comprise a significant proportion our OSCC population. These patients were more likely to be female, older and present with early-stage disease. Tumour site was tongue, maxillary alveolus and buccal mucosa, at variance with the smoker drinker groups. Thus, NSNDs are a clinically distinct and significant group in oral cavity cancer management.

Super-enhancer-driven ameboidal-type cell migration-related MMP14 expression in tongue squamous cell carcinoma switched by BATF and ATF3

BACKGROUND

Tongue squamous cell carcinoma (TSCC) exhibits an aggressive biological behavior of lymph node and distant metastasis, which contributes to poorer prognosis and results in tongue function loss or death. In addition to known regulators and pathways of cell migration in TSCC, it is important to uncover pivotal switches governing tumor metastasis.

METHODS

Cancer cell migration-associated transcriptional and epigenetic characteristics were profiled in TSCC, and the specific super-enhancers (SEs) were identified. Molecular function and mechanism studies were used to investigate the pivotal switches in TSCC metastasis.

RESULTS

Ameboidal-type cell migration-related genes accompanied by transcriptional and epigenetic activity were enriched in TSCC. Meanwhile, the higher-ranked SE-related genes showed significant differences between 43 paired tumor and normal samples from the TCGA TSCC cohort. In addition, key motifs were detected in SE regions, and transcription factor-related expression levels were significantly associated with TSCC survival status. Notably, BATF and ATF3 regulated the expression of ameboidal-type cell migration-related MMP14 by switching the interaction with the SE region.

CONCLUSION

SEs and related key motifs transcriptional regulate tumor metastasis-associated MMP14 and might be potential therapeutic targets for TSCC.

Epidemiological landscape of tongue cancer in younger patients in a National Cancer Center in Brazil

This study investigates the changing epidemiological profile of tongue squamous cell carcinoma (SCC) to young patients, highlighting its rising incidence among non-traditional risk groups. A retrospective descriptive study was conducted, covering data from medical records between 2000 and 2012. Patients were categorised into two age groups (≤ 40 years; 41-50 years). Sociodemographic and clinicopathological characteristics were evaluated. A total of 108 patients participated, mostly aged 41-50. Alcohol consumption (43.3%) surpassed smoking. Majority (56.7%) aged ≤ 40 never smoked. Lateral tongue border was most affected, with stages III and IV prevalent. Patients aged ≤ 40 were mostly eligible for surgery (44%). Survival tied to staging and surgery; age had no significant impact. Young squamous cell carcinoma patients often lacked traditional risk factors like smoking, underwent surgery, and typically had disease-free margins. The study underscores the importance of broad external policies for early diagnosis, beyond just traditional risk groups.

Comparative analysis of clinicopathological characteristics in young and elderly patients with oral squamous cell carcinoma: a retrospective study in Northeastern Brazil

The aim of this study was to perform a clinicopathological analysis of oral squamous cell carcinoma (OSCC) in young patients from the northeast of Brazil and compare with elderly individuals. This retrospective study reviewed 104 OSCC cases from 2000 to 2015, focusing on patients under 40 and over 60 at diagnosis. Forty-two patients under 40 years old (40.38%) and 62 patients over 60 years old (59.62%) were analyzed using descriptive statistics, chi-square, and Fisher's exact tests for clinicopathological factors, and Kaplan-Meier and Cox models for survival and prognostics. Most of the patients were male, with younger patients having lower rates of smoking (45.24%) and alcohol use (28.57%) compared to older patients (82.30% and 40.32%, respectively). Younger patients had a higher prevalence of tongue cancer and smaller tumors but faced more compromised surgical margins, perineural invasion, local recurrence, regional metastasis, distant metastasis, and second primary tumors. Statistical findings highlighted age-related differences in clinicopathological features and indicated that despite similar overall survival rates, younger patients had a poorer prognosis related to local recurrences, regional recurrences, and second tumors. Perineural invasion emerged as an independent prognostic factor. The study suggests that younger OSCC patients require personalized management strategies to address their higher risk of adverse outcomes, with an emphasis on the prognostic significance of perineural invasion.

Role of ENPP1 in cancer pathogenesis: Mechanisms and clinical implications (Review)

Cancer is a significant societal, public health and economic challenge in the 21st century, and is the primary cause of death from disease globally. Ectonucleotide pyrophosphatase/phosphodiesterase (ENPP) serves a crucial role in several biochemical processes, including adenosine triphosphate hydrolysis, purine metabolism and regulation of signaling pathways. Specifically, ENPP1, a type II transmembrane glycoprotein and key member of the ENPP family, may be upregulated in tumor cells and implicated in the pathogenesis of multiple human cancers. The present review provides an overview of the structural, pathological and physiological roles of ENPP1 and discusses the potential mechanisms of ENPP1 in the development of cancers such as breast, colon, gallbladder, liver and lung cancers, and also summarizes the four major signaling pathways in tumors. Furthermore, the present review demonstrates that ENPP1 serves a crucial role in cell migration, proliferation and invasion, and that corresponding inhibitors have been developed and associated with clinical characterization.

Tongue Squamous Cell Carcinoma and Oral Lichen Planus: A Rare Case Report of a Pregnant Woman

Squamous cell carcinoma (SCC) of oral mucosa is increasingly affecting younger individuals, particularly in the tongue. SCC can develop from disorders like oral lichen planus (OLP). This case highlights the first known instance of OLP and SCC in a pregnant woman, suggesting hormonal changes and HPV as possible risk factors.

Oral cavity obliteration is a novel predictor of functional outcomes after glossectomy reconstruction

OBJECTIVES

The primary goal for reconstruction of oral tongue defects is to improve speech and swallowing. The purpose of this study is to present a new reconstructive metric that uses volume displacement to measure oral cavity obliteration and correlate this metric to outcomes of speech and swallowing.

METHODS

47 patients underwent resection and primary closure or free-tissue reconstruction of oral tongue defects. Oral cavity obliteration was measured using a novel oral volume assessment test (OVAT). Briefly, a latex balloon filled with pudding was placed on the patient's tongue and patients performed mouth closure to expel the pudding. Residual volumes represented dead space in the oral cavity and was measured by water displacement. These results were correlated with the Speech and Swallowing Assessment and Assessment of Intelligibility of Dysarthric Speech (AIDS) instruments.

RESULTS

The mean residual volume was 7.4 cc (range 3 - 20 cc; sd 4.5 cc). There was a correlation with lower residual volumes (better obliteration) with increasing AIDS efficiency ratio (R = 0.72, p < 0.001). A receiver operator curve was used to identify 10 cc of residual volume as the optimal cutoff point. Binary logistic regression using this cut point showed that residual volume significantly predicts normal nutritional mode (p < 0.001), ability to tolerate all liquids (p = 0.007), range of solids (p = 0.004), eating in public (p = 0.007), understandability (p < 0.001), and speaking in public (p = 0.01).

CONCLUSIONS

Oral volume assessment test (OVAT) is a novel measure of residual volume (obliteration) that correlates with improved speech efficiency, intelligibility, speaking in public and swallowing outcomes.

Web-based prognostic tools for oral tongue cancer: An analysis of online predictors

BACKGROUND

Oral tongue squamous cell carcinoma (OTSCC) often presents with aggressive clinical behaviour that may require multimodality treatment based on reliable prognostication. We aimed to evaluate the prognostic ability of five online web-based tools to predict the clinical behaviour of OTSCC resection and biopsy samples.

METHODS

A total of 135 OTSCC resection cases and 33 OTSCC biopsies were included to predict recurrence and survival. Area under the receiver operating characteristic curves (AUC), χ2 tests, and calibration plots constructed to estimate the prognostic power of each tool.

RESULTS

The tool entitled 'Prediction of risk of Locoregional Recurrences in Early OTSCC' presented an accuracy of 82%. The tool, 'Head & Neck Cancer Outcome Calculator' for 10-year cancer-related mortality had an accuracy 77% and AUC 0.858. The other tool entitled 'Cancer Survival Rates' for 5-year mortality showed an accuracy of 74% and AUC of 0.723. For biopsy samples, 'Cancer Survival Prediction Calculators' predicted the recurrence free survival with an accuracy of 70%.

CONCLUSIONS

Web-based tools can aid in clinical decision making of OTSCC. Three of five online web-based tools could predict recurrence risk and cancer-related mortality in resected OTSCC and one tool could help in clinical decision making for biopsy samples.

Evaluation of BUBR1, MCM2, and GMNN as oral cancer biomarkers

Oral cancer is a public health problem worldwide. Late diagnosis results in a low survival rate. However, this tumor can arise from oral precancerous lesions and identification of biomarkers in precursor lesions has the potential for early diagnosis, improving patient survival. In this context, proteins involved in the cell cycle control are potentially promising. This study aimed to evaluate the importance of immunohistochemical expression of BUBR1, MCM2, and GMNN as biomarkers of oral carcinogenesis considering different oral sites. Sixty-six samples of oral epithelial dysplasia (from 33 males and 33 females) and 63 samples of oral squamous cell carcinoma (from 44 males and 19 females) were subjected to immunohistochemistry to detect some human proteins. Ki67 expression was included as a marker of cell proliferation. Marker expression was quantified by manually counting at least 1000 cells, and the labeling index was used in all statistical analyses. GMNN, MCM2, BUBR1 (nuclear and cytoplasmic labeling), and Ki67 expression levels were higher in carcinomas than in dysplasia (P < 0.05). Cytoplasmic BUBR1 was a good marker of malignancy (AUC = 0.8525, P < 0.05), but Ki67 was not (AUC = 0.5943, P = 0.0713). GMNN, MCM2, BUBR1, and Ki67 had higher expression in carcinoma than in dysplasia, regardless of the site of the lesion. Cytoplasmic BUBR1 has the potential to be used as a marker of tumor progression.

Depth of invasion and extranodal extension: the influential factors to predict survival rate of patients with oral tongue squamous cell carcinoma

BACKGROUND

Cancer staging is essential in determining patients' prognoses and designing the appropriate treatment strategy. American Joint Committee on Cancer has released the latest version of the staging system for tongue SCC. However, it is interesting to know whether this change in staging and the addition of depth of invasion (DOI) and the extra-nodal extension (ENE) have any influence on patients' prognosis.

METHODS

In this retrospective cohort study, the pathology records of patients with tongue SCC who underwent surgery at the Pathology Department of Cancer Institute Hospital, 2017-2021, were collected by referring to the hospital information system. Then the rate of change of pT, pN, and overall stage were assessed based on American Joint Committee on Cancer 7th and 8th editions.

RESULTS

The records of 204 patients were included in the final analysis. Significant changes in the staging system 2021 resulted in upstaging 64 patients (31.4%) in the overall stage, 91 patients (44.6%) in pT, and 30 patients (14.7%) in pN. The survival of upstaged patients was inferior compared to those without upstaging. However, this was not statistically significant for tumor and overall upstaging in the univariate analysis, while those with upstaged pN had significantly shorter survival. In the multivariate analysis, pT upstage also significantly impacted survival.

CONCLUSION

This study showed the importance of pathology reports based on the latest edition of the American Joint Committee on Cancer, the accuracy in examining factors such as depth of invasion and extra-nodal extension.

Oral Microbiota and the Risk of Gastrointestinal Cancers-A Narrative Literature Review

The human body is colonized by trillions of microorganisms in a symbiotic relationship. The oral cavity represents one of the most abundant microbial habitats in our body. Advances in sequencing techniques provide a more detailed understanding of the oral microbiota and how imbalances between bacteria, the phenomenon of dysbiosis, can affect not only the development of dental caries or inflammation within the oral cavity but also systemic diseases and cancers in distant locations. This narrative review evaluates the relationship between oral microbiota and its impact on gastrointestinal cancers. Using the keywords "oral microbiota 'AND' gastrointestinal cancers", the PubMed Web of Science and Scopus databases were searched for articles published between 2014 and 2024. Based on the review, the relationship between oral microbiota and oral, esophageal, gastric, colorectal, hepatocellular, and pancreatic cancers was described. Potential oncogenic mechanisms exploited by the microbiota such as the production of pro-inflammatory cytokines, induction of abnormal immune responses, and disruption of cell metabolic pathways were assessed. Further research and a thorough understanding of the impact of the oral microbiota on the development of cancers of the gastrointestinal tract may play a key role in their prevention, diagnosis, and treatment in the future.

Epidemiology, Diagnostics, and Therapy of Oral Cancer-Update Review

Oral cavity and lip cancers are the 16th most common cancer in the world. It is widely known that a lack of public knowledge about precancerous lesions, oral cancer symptoms, and risk factors leads to diagnostic delay and therefore a lower survival rate. Risk factors, which include drinking alcohol, smoking, HPV infection, a pro-inflammatory factor-rich diet, and poor oral hygiene, must be known and avoided by the general population. Regular clinical oral examinations should be enriched in an oral cancer search protocol for the most common symptoms, which are summarized in this review. Moreover, new diagnostic methods, some of which are already available (vital tissue staining, optical imaging, oral cytology, salivary biomarkers, artificial intelligence, colposcopy, and spectroscopy), and newly researched techniques increase the likelihood of stopping the pathological process at a precancerous stage. Well-established oral cancer treatments (surgery, radiotherapy, chemotherapy, and immunotherapy) are continuously being developed using novel technologies, increasing their success rate. Additionally, new techniques are being researched. This review presents a novel glance at oral cancer-its current classification and epidemiology-and will provide new insights into the development of new diagnostic methods and therapies.

Procaine induces cell cycle arrest, apoptosis and autophagy through the inhibition of the PI3K/AKT and ERK pathways in human tongue squamous cell carcinoma

Procaine (PCA), a local anesthetic commonly used in stomatology, exhibits antitumor activity in some human malignancies. However, the precise mechanism underlying PCA activity remains unknown, and its antitumor effect in human tongue squamous carcinoma cells has not been reported. Flow cytometry and western blotting were used to assess the effects of PCA on mitochondrial membrane potential (ΔΨm), intracellular reactive oxygen species (ROS) production, cell cycle and apoptosis. The results suggested that PCA inhibits CAL27 and SCC-15 cell proliferation, and clone formation in a dose-dependent manner. CAL27 cells were more sensitive to PCA than SCC-15 cells. PCA also significantly inhibited cell migration, induced mitochondrial damage, reduced ΔΨm and increased intracellular ROS production. PCA causes G2/M cycle arrest and induces apoptosis. The possible mechanism for the inhibition of human tongue squamous carcinoma cell proliferation is through the regulation of ERK phosphorylation and PI3K/AKT-mediated signaling pathways. The results further suggested that autophagy occurs during PCA-induced apoptosis in CAL27 cells, and the addition of the autophagy inhibitor hydroxychloroquine sulfate further enhanced the sensitivity of PCA to inhibit cell proliferation, indicating that autophagy plays an important role in protecting cancer cells from apoptosis. PCA shows potential as an anticancer drug and its combination with autophagy inhibitors enhances its sensitivity.

The potential of hydrogel-free tumoroids in head and neck squamous cell carcinoma

BACKGROUND

Head and neck malignancy, and in particular squamous cell carcinoma (SCC), is responsible for a significant disease burden globally. The lack of an optimal in vitro model system to accurately recapitulate in vivo response to therapy in HNSCC remains a challenge. The development of patient-derived three-dimensional tumour cultures, or tumoroids, has enabled improved modelling of the tumour microenvironment through simulation of important characteristics such as tumour hypoxia, cell-cell interactions and nutrient diffusion characteristics.

METHODS

We performed a comprehensive English-language literature review of current methods of tumoroid development utilising Matrigel and Cultrex Basement Membrane Extract 2 (key terms: tumour organoids, tumoroids, hydrogels, Matrigel, Cultrex, squamous cell carcinoma, head and neck)-two common proprietary murine-derived hydrogels containing extracellular matrix proteins. Nascent literature on the establishment of a novel hydrogel-free platform for tumoroid development as distinct from these existing methods was also explored.

RESULTS

Whilst useful for facilitating cell-matrix interactions and providing a scaffold for three-dimensional cell growth and organisation, murine-derived cell matrix methods were noted to have notable limitations including temperature sensitivity and the medium forming a barrier to analysis of the supernatant. A novel hydrogel-free method of establishing in vitro tumoroid cultures has been subject to experimentation in colorectal but not head and neck malignancy. The absence of a hydrogel provides for the de novo synthesis of extracellular matrix native to the tumour and self-organisation of cells within this scaffold through the use of ultralow attachment plates. This model demonstrates similar structural and physiological properties to native tissue, whilst enabling more accurate biomimicry of the tumour microenvironment for drug testing.

CONCLUSIONS

In the absence of prior experimentation on a hydrogel-free method for establishing HNSCC tumoroids, and comparisons between hydrogel and hydrogel-free models, the future development of a comparative protocol encompassing recruitment, collection, processing and analysis represents a valuable opportunity.

Feasibility of a Novel 3D Ultrasound Imaging Technique for Intraoperative Margin Assessment during Tongue Cancer Surgery

Squamous cell carcinoma (SCC) of the tongue is the most prevalent form of oral cavity cancer, with surgical intervention as the preferred method of treatment. Achieving negative or free resection margins of at least 5 mm is associated with improved local control and prolonged survival. Nonetheless, margins that are close (1-5 mm) or positive (less than 1 mm) are often observed in practice, especially for the deep margins. Ultrasound is a promising tool for assessing the depth of invasion, providing non-invasive, real-time imaging for accurate evaluation. We conducted a clinical trial using a novel portable 3D ultrasound imaging technique to assess ex vivo surgical margin assessment in the operating room. During the operation, resected surgical specimens underwent 3D ultrasound scanning. Four head and neck surgeons measured the surgical margins (deep, medial, and lateral) and tumor area on the 3D ultrasound volume. These results were then compared with the histopathology findings evaluated by two head and neck pathologists. Six patients diagnosed with tongue SCC (three T1 stage and three T2 stage) were enrolled for a consecutive cohort. The margin status was correctly categorized as free by 3D ultrasound in five cases, and one case with a "free" margin status was incorrectly categorized by 3D ultrasound as a "close" margin. The Pearson correlation between ultrasound and histopathology was 0.7 (p < 0.001), 0.6 (p < 0.001), and 0.3 (p < 0.05) for deep, medial, and lateral margin measurements, respectively. Bland-Altman analysis compared the mean difference and 95% limits of agreement (LOA) for deep margin measurement by 3D ultrasound and histopathology, with a mean difference of 0.7 mm (SD 1.15 mm). This clinical trial found that 3D ultrasound is accurate in deep margin measurements. The implementation of intraoperative 3D ultrasound imaging of surgical specimens may improve the number of free margins after tongue cancer treatment.

Role of Mesenchymal Stem/Stromal Cells in Head and Neck Cancer-Regulatory Mechanisms of Tumorigenic and Immune Activity, Chemotherapy Resistance, and Therapeutic Benefits of Stromal Cell-Based Pharmacological Strategies

Head and neck cancer (HNC) entails a heterogenous neoplastic disease that arises from the mucosal epithelium of the upper respiratory system and the gastrointestinal tract. It is characterized by high morbidity and mortality, being the eighth most common cancer worldwide. It is believed that the mesenchymal/stem stromal cells (MSCs) present in the tumour milieu play a key role in the modulation of tumour initiation, development and patient outcomes; they also influence the resistance to cisplatin-based chemotherapy, the gold standard for advanced HNC. MSCs are multipotent, heterogeneous and mobile cells. Although no MSC-specific markers exist, they can be recognized based on several others, such as CD73, CD90 and CD105, while lacking the presence of CD45, CD34, CD14 or CD11b, CD79α, or CD19 and HLA-DR antigens; they share phenotypic similarity with stromal cells and their capacity to differentiate into other cell types. In the tumour niche, MSC populations are characterized by cell quiescence, self-renewal capacity, low reactive oxygen species production and the acquisition of epithelial-to-mesenchymal transition properties. They may play a key role in the process of acquiring drug resistance and thus in treatment failure. The present narrative review examines the links between MSCs and HNC, as well as the different mechanisms involved in the development of resistance to current chemo-radiotherapies in HNC. It also examines the possibilities of pharmacological targeting of stemness-related chemoresistance in HNSCC. It describes promising new strategies to optimize chemoradiotherapy, with the potential to personalize patient treatment approaches, and highlights future therapeutic perspectives in HNC.

Impact of Human Papillomavirus on microRNA-21 Expression in Oral and Oropharyngeal Cancer-A Systematic Review

Recently, microRNAs (miR) were identified to have potential links with oral squamous cell carcinoma (OSCC) and oropharyngeal squamous cell carcinoma (OPSCC) oncogenesis, specifically miR-21. Since HPV is a major risk factor for the development of these diseases, we aimed to search the literature regarding miR-21 expression in both HPV-positive and HPV-negative OSCC/OPSCC. The search was performed in the PubMed (MEDLINE), Scopus, Web of Science, and Cochrane electronic databases. The research question was as follows: Is there a difference in the tissue expression of miR-21 between patients with HPV-positive and those with HPV-negative OSCC/OPSCC? After conducting a meticulous search strategy, four studies were included, and they had a pooled sample size of 621 subjects with OSCC and/or OPSCC. Three studies did not find any significant difference in miR-21 expression between HPV-positive and HPV-negative OSCC/OPSCC. The findings of this systematic review showed that there are no differences in miR-21 expression between HPV-positive and HPV-negative OSCC/OPSCC. Nevertheless, it is worth noting that there are still insufficient studies regarding this important subject, because understanding how HPV influences miR-21 expression and its downstream effects can provide insights into the molecular mechanisms underlying OSCC/OPSCC development and progression.

Understanding the nucleotide composition and patterns of codon usage in the expression of human oral cancer genes

Oral squamous cell carcinoma (OSCC) is primarily known as oral cancer (OC) that mostly occurs in mouth, lips and tongue. Mutations in some of the genes cause OC and some genes are risk factors for progression of OC. In this study, we analyzed the compositional features and pattern of codon usage in genes involved in OC using computational method as no work was reported yet. Compositional features suggested that the overall GC content was higher i.e. genes were GC rich. Effective number of codons (ENC) values ranged from 34.6 to 55.9 with a mean value of 49.03±4.22 representing low codon usage bias (CUB). Correspondence analysis (COA) suggested that the codon usage pattern was different in different genes. In genes associated with OC, highly significant correlation was observed between GC12 and GC3 (r=0.454, p<0.01) suggesting that directional mutation affected all the three codon positions. This is the first report on pattern of codon usage pattern on genes involved in OC, which not only alludes a new perspective for elucidating the mechanisms of biased usage of synonymous codons but also provide valuable clues for molecular genetic engineering.

Novel prognostic nomograms for postoperative patients with oral cavity squamous cell carcinoma in the central region of China

BACKGROUND

Oral cavity squamous cell carcinoma (OCSCC) is the most common pathological type in oral tumors. This study intends to construct a novel prognostic nomogram model based on China populations for these resectable OCSCC patients, and then validate these nomograms.

METHODS

A total of 607 postoperative patients with OCSCC diagnosed between June 2012 and June 2018 were obtained from two tertiary medical institutions in Xinxiang and Zhengzhou. Then, 70% of all the cases were randomly assigned to the training group and the rest to the validation group. The endpoint time was defined as overall survival (OS) and disease-free survival (DFS). The nomograms for predicting the 3-, and 5-year OS and DFS in postoperative OCSCC patients were established based on the independent prognostic factors, which were identified by the univariate analysis and multivariate analysis. A series of indexes were utilized to assess the performance and net benefit of these two newly constructed nomograms. Finally, the discrimination capability of OS and DFS was compared between the new risk stratification and the American Joint Committee on Cancer (AJCC) stage by Kaplan-Meier curves.

RESULTS

607 postoperative patients with OCSCC were selected and randomly assigned to the training cohort (n = 425) and validation cohort (n = 182). The nomograms for predicting OS and DFS in postoperative OCSCC patients had been established based on the independent prognostic factors. Moreover, dynamic nomograms were also established for more convenient clinical application. The C-index for predicting OS and DFS were 0.691, 0.674 in the training group, and 0.722, 0.680 in the validation group, respectively. Besides, the calibration curve displayed good consistency between the predicted survival probability and actual observations. Finally, the excellent performance of these two nomograms was verified by the NRI, IDI, and DCA curves in comparison to the AJCC stage system.

CONCLUSION

The newly established and validated nomograms for predicting OS and DFS in postoperative patients with OCSCC perform well, which can be helpful for clinicians and contribute to clinical decision-making.

Insights into the role of the N6-methyladenosine reader IGF2BP3 in the progression of oral squamous cell carcinoma and its connection to cell-cycle control

The genome of oral squamous cell carcinoma (OSCC) has been extensively characterized via bulk sequencing, revealing a multitude of genetic changes. The gene IGF2BP3, which encodes for the insulin-like growth factor 2 mRNA-binding protein 3, has been observed to be highly expressed in several types of cancer. This finding suggests that IGF2BP3 may play a significant role in the initiation and advancement of cancer. Nevertheless, the mechanisms by which IGF2BP3 contribute to OSCC are yet to be fully understood. In this study, we have observed that IGF2BP3 exhibits overexpression in OSCC. Based on our findings from bulk sequencing analysis, we have concluded that IGF2BP3 could potentially serve as a biomarker for predicting poor prognosis in OSCC. Moreover, it has been demonstrated that IGF2BP3 exhibits a significant association with the initiation and advancement of tumors both in vivo and in vitro. The evaluation of IGF2BP3 expression levels in relation to the cell cycle stage was conducted using single-cell RNA sequencing data. Tumor cells characterized by elevated IGF2BP3 expression demonstrated a higher percentage of cells in the G2/M transition phase. This study presents new findings indicating that the molecular target IGF2BP3 can serve as a prognostic indicator for tumors and has an impact on the development and progression of OSCC by influencing the regulation of the cell cycle.

Tongue cancer in non-smoking and non-alcoholic mother and daughter

Tongue cancer is more prevalent in male smokers and alcoholics. Although an increased incidence of tongue cancer has been noted in non-smoking and non-alcoholic women, reports of its occurrence in mother and daughter are extremely rare. Here, we report a case of a non-smoking and non-alcoholic mother and her daughter diagnosed and treated surgically for tongue squamous cell carcinoma (SCC). The daughter is still being monitored and the mother died from complications from COVID-19 after 6 years of treatment. This report shows that OSCC should be considered in the differential diagnosis of oral ulcerated lesions in non-smoking and non-alcoholic women, especially if there is a family history of first-degree oral cancer.

The effects of re-irradiation on the chemical and morphological properties of permanent teeth

This study aimed to assess the in vitro effects of re-irradiation on enamel and dentin properties, simulating head and neck cancer radiotherapy retreatment. Forty-five human permanent molars were classified into five groups: non-irradiated; irradiated 60 Gy, and re-irradiated with doses of 30, 40, and 50 Gy. Raman spectroscopy, scanning electron microscopy (SEM), and energy dispersive x-ray spectroscopy (EDS) were employed for analysis. Raman spectroscopy assessed intensity, spectral area, and specific peaks comparatively. Statistical analysis involved Kolmogorov-Smirnov and One-Way ANOVA tests, with Tukey's post-test (significance level set at 5%). Significant changes in irradiated, non-irradiated, and re-irradiated enamel peaks were observed, including phosphate (438 nm), hydroxyapatite (582 nm), phosphate (960 nm), and carbonate (1070 nm) (p < 0.05). Re-irradiation affected the entire tooth (p > 0.05), leading to interprismatic region degradation, enamel prism destruction, and hydroxyapatite crystal damage. Dentin exhibited tubule obliteration, crack formation, and progressive collagen fiber fragmentation. EDX revealed increased oxygen percentage and decreased phosphorus and calcium post-reirradiation. It is concluded that chemical and morphological changes in irradiated permanent teeth were dose-dependent, exacerbated by re-irradiation, causing substantial damage in enamel and dentin.

Prognostic Significance of Regional Disease in Young Patients with Oral Cancer: A Comparative Study

BACKGROUND

Regional metastases are considered the most important prognostic factor in OSCC patients. We aimed to investigate the impact of regional disease among different age groups with OSCC.

METHODS

A retrospective comparison between patients 40 years old or younger, 41-69 years old, and 70 years or older treated for OSCC between 2000 and 2020 in a tertiary-care center.

RESULTS

279 patients were included. The mean age was 65 ± 17.7 and 133 were male (47.7%). Thirty-six (12.9%) were 40 years old or younger, 101 (36.2%) were 41-69 years and 142 (50.9%) were 70 years or older. Five-year overall survival and disease-specific survival (DSS) were significantly better among patients younger than 40 compared to the mid-age group and patients 70 years or older (76.7% vs. 69.4% vs.48.2%, Log-rank p < 0.001, and 76.7% vs. 75.3% vs. 46.5%, Log-rank p < 0.001, respectively). While an association between regional spread and overall survival and DSS was demonstrated among all age groups, the odds ratio (OR) for death of any cause and death of disease regarding cervical metastasis was much higher among patients younger than 40 compared with the 41-69 and 70+ age groups (death of any cause-OR = 23, p-value = 0.008, OR = 2.6, p-value = 0.026, OR = 2.4, p-value = 0.13, respectively. Death of disease-OR = 23, p-value = 0.008, OR = 2.3, p-value = 0.082, OR = 4.1, p-value = 0.001, respectively). In univariate  analysis, regional metastasis was associated with disease-free survival only among patients younger than 40 (p-value = 0.04).

CONCLUSIONS

Regional metastases correspond with worse prognosis in young patients compared to older patients. These patients may benefit from a comprehensive treatment approach with close post-treatment follow-up.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:2212-2220, 2024.

Occupation and tongue cancer in Nordic countries

PURPOSE

Almost 200,000 tongue cancers were diagnosed worldwide in 2020. The aim of this study was to describe occupational risk variation in this malignancy.

METHODS

The data are based on the Nordic Occupational Cancer (NOCCA) study containing 14.9 million people from the Nordic countries with 9020 tongue cancers diagnosed during 1961-2005. The standardized incidence ratio (SIR) of tongue cancer in each occupational category was calculated using national incidence rates as the reference.

RESULTS

Among men, the incidence was statistically significantly elevated in waiters (SIR 4.36, 95% confidence interval (CI) 3.13--5.92), beverage workers (SIR 3.42, 95% CI 2.02-5.40), cooks and stewards (SIR 2.55, 95% CI 1.82-3.48), seamen (SIR 1.66, 95% CI 1.36-2.00), journalists (SIR 1.85, 95% CI 1.18-2.75), artistic workers (SIR 2.05, 95% CI 1.54-2.66), hairdressers (SIR 2.17, 95% CI 1.39-3.22), and economically inactive persons (SIR 1.57, 95% CI 1.42-1.73). Among women, the SIR was statistically significantly elevated only in waitresses (SIR 1.39, 95% CI 1.05-1.81). Statistically significant SIRs ≤ 0.63 were observed in male farmers, gardeners, forestry workers and teachers, and in female launderers.

CONCLUSIONS

These findings may be related to consumption of alcohol and tobacco, but the effect of carcinogenic exposure from work cannot be excluded.

Survival among treated tongue cancer patients: a single-center experience

OBJECTIVE

To describe overall survival (OS) and disease-free survival (DFS) in a cohort of tongue cancer patients, together with the corresponding demographic, tumor and surgical characteristics.

METHODS

A retrospective study was made of 205 consecutive patients with primary tongue cancer subjected to surgery and adjuvant therapy according to the stage of the disease, in Hospital Clínico Universitario Virgen de la Arrixaca (HUVA) (Murcia, Spain) during the period 2000-2020. Survival was evaluated based on the Kaplan-Meier method, and the existence of significant differences between the different study variables was analyzed using the log-rank test. Cox regression analysis was performed for the identification of risk factors.

RESULTS

In relation to overall survival, 72.6% of the patients survived for a mean time of 14.43 years [standard error (SE) = 0.74; 95% CI: 12.98-15.87], with a cumulative survival rate of 49.8 ± 3%. Survival was reduced by the presence of tumor adjacent to resection margins [hazard ratio (HR) 2.20; 95% CI 1.09-4.43] (p = 0.028) and infiltrated resection margins (HR 3.86, 95% CI 1.56-9.57) (p = 0.004). Lymphadenectomy in turn increased survival (HR 0.15; 95% CI 0.06-0.42) (p < 0.001). In relation to disease-free survival, 55.3% of the patients suffered no relapse over a mean period of 9.91 years (SE = 0.66; 95% CI: 8.61-11.2), with a cumulative survival rate of 26.6% ± 8.4%.

CONCLUSIONS

In tongue cancer patients, overall and specific survival were reduced in the presence of infiltrated resection margins. Lymphadenectomy in turn improved survival compared with patients in which this procedure was not carried out.

Impact of the COVID-19 Pandemic on Head and Neck Cancer Management: The Experience of the Maxillo-Facial Surgery Department of a French Regional Referral Center in a High-Incidence Area

Background: Cancer patients are at a high risk of complications in cases of infection, and head and neck cancers (HNC) are no exception. Since late 2019, SARS-CoV-2 has caused a global health crisis, with high rates and severe forms of the disease in cancer patients. Hospitalization, surgery and radiotherapy were rapidly described as increasing the risk of infection. Since March 2020, the Amiens University Hospital (France) has been taking care of COVID-19 patients while its maxillofacial surgery department managed HNC patients without interruption, even during lockdown periods. However, many questions concerning the impact on patient care were still pending. The aim of this study is to describe HNC management in our center during the first epidemic peak and to evaluate the impact of containment measures on patient treatment. Methods: We retrospectively included 44 HNC patients treated in our department between 1 March and 31 August 2020. Two groups were defined according to the period of care: lockdown (March to May) and lighter restrictions (June to August). Results: The results show typical epidemiological characteristics, maintained management times and non-downgraded procedures. Conclusions: Thus, during the first epidemic peak, continuity of care and patients' safety could be ensured thanks to adequate means, adapted procedures and an experienced surgical team.

Stimulator of Interferon Genes Pathway Activation through the Controlled Release of STINGel Mediates Analgesia and Anti-Cancer Effects in Oral Squamous Cell Carcinoma

Oral squamous cell carcinoma (OSCC) presents significant treatment challenges due to its poor survival and intense pain at the primary cancer site. Cancer pain is debilitating, contributes to diminished quality of life, and causes opioid tolerance. The stimulator of interferon genes (STING) agonism has been investigated as an anti-cancer strategy. We have developed STINGel, an extended-release formulation that prolongs the availability of STING agonists, which has demonstrated an enhanced anti-tumor effect in OSCC compared to STING agonist injection. This study investigates the impact of intra-tumoral STINGel on OSCC-induced pain using two separate OSCC models and nociceptive behavioral assays. Intra-tumoral STINGel significantly reduced mechanical allodynia in the orofacial cancer model and alleviated thermal and mechanical hyperalgesia in the hind paw model. To determine the cellular signaling cascade contributing to the antinociceptive effect, we performed an in-depth analysis of immune cell populations via single-cell RNA-seq. We demonstrated an increase in M1-like macrophages and N1-like neutrophils after STINGel treatment. The identified regulatory pathways controlled immune response activation, myeloid cell differentiation, and cytoplasmic translation. Functional pathway analysis demonstrated the suppression of translation at neuron synapses and the negative regulation of neuron projection development in M2-like macrophages after STINGel treatment. Importantly, STINGel treatment upregulated TGF-β pathway signaling between various cell populations and peripheral nervous system (PNS) macrophages and enhanced TGF-β signaling within the PNS itself. Overall, this study sheds light on the mechanisms underlying STINGel-mediated antinociception and anti-tumorigenic impact.

RUVBL1 accelerates tongue squamous cell carcinoma by mediating CRaf/MEK/ERK pathway

RAF/MEK/ERK pathway is frequently activated in tumor. Therefore, this study will investigate the function of RUVBL1 (RAF-binding protein) in tongue squamous cell carcinoma (TSCC). Bioinformatics was performed to identify differentially expressed mRNAs (DE-mRNAs) in TCGA-oral squamous cell carcinoma, GSE13601, and GSE34105 datasets. A total of 672 shared DE-mRNAs were identified in three datasets, and they are regulating metastasis and angiogenesis. Patients with RUVBL1 low expression had high overall survival. Overexpressing RUVBL1 enhanced the viability, wound healing percentage, invasion, sphere formation, angiogenesis, and resistance to cisplatin and 5-fluorouracil in CAL-27 and SCC-4 cells, and the opposite results were obtained by knocking down RUVBL1. Moreover, overexpression of RUVBL1 bolstered tumor growth in vivo. Strikingly, RUVBL1 diminished the phosphorylation of CRAF Ser259, which led to activation of the MEK/ERK pathway. In conclusion, RUVBL1 contributes to the malignant biological behavior of TSCC via activating the CRAF/MEK/ERK pathway. This provides molecular mechanisms and perspectives for targeted therapy of the CRAF/MEK/ERK pathway.

A Review of the Repair of DNA Double Strand Breaks in the Development of Oral Cancer

We explore the possibility that defects in genes associated with the response and repair of DNA double strand breaks predispose oral potentially malignant disorders (OPMD) to undergo malignant transformation to oral squamous cell carcinoma (OSCC). Defects in the homologous recombination/Fanconi anemia (HR/FA), but not in the non-homologous end joining, causes the DNA repair pathway to appear to be consistent with features of familial conditions that are predisposed to OSCC (FA, Bloom's syndrome, Ataxia Telangiectasia); this is true for OSCC that occurs in young patients, sometimes with little/no exposure to classical risk factors. Even in Dyskeratosis Congenita, a disorder of the telomerase complex that is also predisposed to OSCC, attempts at maintaining telomere length involve a pathway with shared HR genes. Defects in the HR/FA pathway therefore appear to be pivotal in conditions that are predisposed to OSCC. There is also some evidence that abnormalities in the HR/FA pathway are associated with malignant transformation of sporadic cases OPMD and OSCC. We provide data showing overexpression of HR/FA genes in a cell-cycle-dependent manner in a series of OPMD-derived immortal keratinocyte cell lines compared to their mortal counterparts. The observations in this study argue strongly for an important role of the HA/FA DNA repair pathway in the development of OSCC.

SOX9 promotes stemness in the CAL27 cell line of tongue squamous cell carcinoma

Tongue squamous cell carcinoma (TSCC) is a prevalent form of oral malignancy, with increasing incidence. Unfortunately, the 5-year survival rate for patients has not exceeded 50%. Studies have shown that sex-determining region Y box 9 (SOX9) correlates with malignancy and tumor stemness in a variety of tumors. To investigate the role of SOX9 in TSCC stemness, we analyzed its influence on various aspects of tumor biology, including cell proliferation, migration, invasion, sphere and clone formation, and drug resistance in TSCC. Our data suggest a close association between SOX9 expression and both the stemness phenotype and drug resistance in TSCC. Immunohistochemical experiments revealed a progressive increase of SOX9 expression in normal oral mucosa, paracancerous tissues, and tongue squamous carcinoma tissues. Furthermore, the expression of SOX9 was closely linked to the TNM stage, but not to lymph node metastasis or tumor diameter. SOX9 is a crucial gene in TSCC responsible for promoting the stemness function of cancer stem cells. Developing drugs that target SOX9 is extremely important in clinical settings.

Chemerin promotes invasion of oral squamous cell carcinoma by stimulating IL-6 and TNF-α production via STAT3 activation

AIMS

Elevated levels of adipokine chemerin have been identified in oral squamous cell carcinoma (OSCC) and found to be associated with metastasis to the cervical lymph nodes. The underlying mechanism through which chemerin affects OSCC progression is unclear. The aims of this study were firstly to determine chemerin levels and cytokine concentrations in serum from patients with OSCC and in OSCC cell cultures, and secondly to observe chemerin effects on OSCC cell cytokine secretion, migration, and invasion in vitro.

METHODS

Serum samples were collected from 20 patients diagnosed with OSCC, including groups with (LN+) and without (LN-) cervical lymph node metastasis. A Luminex liquid suspension assay was used to quantify serum concentrations of 27 types of cytokines. Correlations between chemerin and cytokines (i.e., IL-6, IL-15, GM-CSF, RANTES, TNF-α, and VEGF) were analyzed. ELISAs (enzyme-linked immunosorbent assays) were used to determine concentrations of chemerin and selected cytokines in serum and in supernatants of OSCC cell cultures (SCC9 and SCC25 cell lines). OSCC cells were stimulated with human recombinant chemerin, STAT3 inhibitor, or IL-6 together with TNF-α neutralizing antibodies. Phosphorylated STAT3 protein levels were measured with western blot analysis. OSCC cell migration and invasion were investigated with Transwell assays.

RESULTS

Compared to the LN- group, OSCC patients with cervical lymph node metastasis had higher levels of IL-6 (P = 0.006), IL-15 (P = 0.020), GM-CSF (P = 0.036), RANTES (P = 0.032), TNF-α (P = 0.005), VEGF (P = 0.006), and chemerin (P = 0.001). Patients' serum chemerin levels correlated directly with IL-6, GM-CSF, TNF-α, and VEGF levels in OSCC patients. Exogenous recombinant chemerin treatment promoted secretion of IL-6 and TNF-α via activation of STAT3 in OSCC cells. Chemerin induced OSCC-cell migration and invasion, and these effects were reduced by IL-6 and TNF-α neutralizing antibodies.

CONCLUSION

Our findings indicate that chemerin may play a role in advancing OSCC progression by increasing production of IL-6 and TNF-α, perhaps via a mechanism involving STAT3 signaling.

The application of radiomics machine learning models based on multimodal MRI with different sequence combinations in predicting cervical lymph node metastasis in oral tongue squamous cell carcinoma patients

BACKGROUND

The purpose of this study was to explore preliminary the performance of radiomics machine learning models based on multimodal MRI to predict the risk of cervical lymph node metastasis (CLNM) for oral tongue squamous cell carcinoma (OTSCC) patients.

METHODS

A total of 400 patients were enrolled in this study and divided into six groups according to the different combinations of MRI sequences. Group I consisted of patients with T1-weighted images (T1WI) and FS-T2WI (fat-suppressed T2-weighted images), group II consisted of patients with T1WI, FS-T2WI, and contrast enhanced MRI (CE-MRI), group III consisted of patients with T1WI, FS-T2WI, and T2-weighted images (T2WI), group IV consisted of patients with T1WI, FS-T2WI, CE-MRI, and T2WI, group V consisted of patients with T1WI, FS-T2WI, T2WI, and apparent diffusion coefficient map (ADC), and group VI consisted of patients with T1WI, FS-T2WI, CE-MRI, T2WI, and ADC. Machine learning models were constructed. The performance of the models was compared in each group.

RESULTS

The machine learning model in group IV including T1WI, FS-T2WI, T2WI, and CE-MRI presented best prediction performance, with AUCs of 0.881 and 0.868 in the two sets. The models with CE-MRI performed better than the models without CE-MRI(I vs. II, III vs. IV, V vs. VI).

CONCLUSIONS

The radiomics machine learning models based on CE-MRI showed great accuracy and stability in predicting the risk of CLNM for OTSCC patients.

Predictive value of systemic inflammatory response-related indices for survival in tongue cancer

OBJECTIVES

We assessed the potential prognostic significance of the preoperative systemic inflammation index, platelet-to-lymphocyte ratio, and neutrophil-to-lymphocyte ratio in patients who underwent surgical resection.

SUBJECTS AND METHODS

This retrospective study included 224 patients with clinicopathologically confirmed squamous carcinoma of the tongue who underwent surgery between August 2009 and December 2017. The optimal cut-off values for the indices were determined by receiver operating characteristic curves. Correlations between the indices and clinicopathological variables were determined by Pearson chi-square or Fisher exact tests. The Kaplan-Meier test was used to compare overall survival between groups (high and low values); the log-rank or Breslow test was used to assess differences in survival. Univariate and multivariate Cox regression models were used to analyze predictive values of the indices as independent indicators of overall survival. Bilateral p values of <0.05 were considered statistically significant.

RESULTS

Significant association was found between the indices and sex, tissue grade, tumor location, and lymph nodes metastases (p < 0.05). On Kaplan-Meier analysis, patients with lower values of the indices had longer overall survival (p < 0.05). Univariate and multivariate Cox regression models identified age, lymph node metastases, and neutrophil-to-lymphocyte ratio as independent predictors of overall survival.

CONCLUSION

The studied indices have potential prognostic significance in patients with squamous tongue cancer.

Prognostic nomogram for patients with tongue squamous cell carcinoma: A SEER-based study

OBJECTIVES

In order to predict the patients' prognosis with tongue squamous cell carcinoma (SCC), this study set out to develop a clinically useful and trustworthy prognostic nomogram.

SUBJECTS AND METHODS

The Surveillance, Epidemiology, and End Results (SEER) Program was used to compile clinical information on patients with tongue SCC between 2010 and 2015. The likelihood of Cancer-Specific Survival (CSS) and Overall Survival (OS) for specific patients was predicted using a prognostic nomogram created with the help of the RStudio software. The nomogram's predictive ability was evaluated using the consistency index (C-index) and decision curve analysis, and the nomogram was calibrated for 1-, 2-, 3-, 5-, and 10-year CSS and OS.

RESULTS

Patients numbering 6453were enrolled in this study. The primary cohort (3895) and validation cohort (2558) were each randomly assigned. Sex, age, tumor-node-metastasis (TNM) stage, surgery, chemotherapy, and radiation were significant risk factors for OS, whereas age, TNM stage, surgery, chemotherapy, and radiotherapy were significant risk factors for CSS. Additionally, C-index and calibration curves indicated that the prognostic nomogram prediction and the actual observation in both cohorts would be very coherent.

CONCLUSIONS

The predictive nomogram created in this study can offer patients with tongue SCC customized treatment and survival risk assessment.

Role of Lymphovascular Invasion in Oral Cavity Squamous Cell Carcinoma Regional Metastasis and Prognosis

OBJECTIVE

The overall 5-year survival for oral squamous cell carcinoma (OSCC) has not changed in the last 20 years despite advances in treatment. Lymphovascular invasion (LVI) has been shown to be a negative prognostic factor in other cancers, however its role in the prognosis of OSCC remains unclear. This study aims to determine if LVI is a predictor of cervical lymph node metastasis and/or recurrence in OSCC.

METHODS

We conducted a retrospective cohort review of patients from our institutional cancer registry who were treated for OSCC between 2004 and 2018. Patient demographics, surgical pathology results, and clinical outcome data were collected. A multivariable logistic regression analysis was performed to determine if LVI was an independent predictor of cervical lymph node metastasis and/or recurrence.

RESULTS

442 patients were included, 32.8% were female and median age at time of diagnosis was 61.2 years. LVI was present in 32.8% of patients. When controlled for age, sex, t-classification, perineural invasion, depth of invasion (DOI), and margin status, LVI was a significant predictor of the presence of cervical node metastasis (OR: 3.42, CI: 2.17-5.39, P < .001). There was no significant association found between LVI and local recurrence (OR: 1.03, CI: 0.57-1.84, P = .92), regional recurrence (OR: 1.10, CI: 0.57-2.11, P = .78), or distant recurrence (OR: 1.59, CI: 0.87-2.94, P = .13).

CONCLUSION

The results of this study suggest that LVI is a significant predictor of the presence of cervical lymph node metastasis at presentation independent of other known prognostic factors. LVI, however, was not found to be a significant independent predictor of locoregional or distant recurrence.Level of Evidence: Level III.

Intraoral Ultrasound versus MRI for Depth of Invasion Measurement in Oral Tongue Squamous Cell Carcinoma: A Prospective Diagnostic Accuracy Study

Oral squamous cell carcinoma (OSCC) of the tongue is the most common type of oral cavity cancer, and tumor depth of invasion (DOI) is an important prognostic factor. In this study, we investigated the accuracy of intraoral ultrasound and magnetic resonance imaging (MRI) for assessing DOI in patients with OSCC. Histopathological measurement of DOI was used as a reference standard. We conducted a prospective study including patients planned for surgical treatment of OSCC in the tongue. The DOI was measured in an outpatient setting by intraoral ultrasound and MRI, and was compared to the histopathological DOI measurements. Bland-Altman analysis compared the mean difference and 95% limits of agreement (LOA) for ultrasound and MRI, and the Wilcoxon signed-rank test was used to test for significance. The correlation was evaluated using Pearson's correlation coefficient. We included 30 patients: 26 with T1 or T2 tumors, and 4 with T3 tumors. The mean difference from histopathology DOI was significantly lower for ultrasound compared to MRI (0.95 mm [95% LOA -4.15 mm to 6.06 mm] vs. 1.90 mm [95% LOA -9.02 mm and 12.81 mm], p = 0.023). Ultrasound also led to significantly more correct T-stage classifications in 86.7% (26) of patients compared to 56.7% (17) for MRI, p = 0.015. The Pearson correlation between MRI and histopathology was 0.57 (p < 0.001) and the correlation between ultrasound and histopathology was 0.86 (p < 0.001). This prospective study found that intraoral ultrasound is more accurate than MRI in assessing DOI and for the T-staging of oral tongue cancers. Clinical practice and guidelines should implement intraoral ultrasound accordingly.