Analysis of survival rates and prognostic factors among patients with oral squamous cell carcinoma

Correlation of preoperative 18F-FDG-PET/CT tumor staging and maximum standardized uptake values with preoperative CT, postoperative tumor classification, and histopathological parameters of oral squamous cell carcinoma

INTRODUCTION

This study aimed to correlate preoperative 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) tumor staging, and maximum standardized uptake values (SUVmax) with preoperative CT data, postoperative tumor classification, and histopathological parameters of oral squamous cell carcinoma (OSCC).

MATERIAL AND METHODS

Thirty-seven OSCC patients staged via full-body 18F-FDG-PET/CT, including contrast agent CT of the head and neck in 2020 and 2021, were enclosed. Patients received tumor resection and stage-dependent neck dissection. Preoperative clinical (c) 18F-FDG-PET/CT UICC tumor stages and TNM classifications were correlated to corresponding CT and to postoperative histopathological (p) UICC tumor stages and TNM classifications. SUVmax of the primary tumor was associated with pUICC and pTNM, including extranodal extension (ENE), perineural invasion (Pn), lymphatic spread (L), vascular invasion (V), tumor grading (G), and -thickness.

RESULTS

Comparing 18F-FDG-PET/CT and CT, cUICC, cT, and cN differed in 32.3%, 16.7%, and 37.8% of the cases, respectively. For 18F-FDG-PET/CT, a moderate correlation was found between c- and pUICC (0.494; p = 0.0018) with a misestimation of c- compared to pUICC in 43.2% of the cases. Comparing c- and pTNM, misestimations concerning c- and pT were seen in 51.4% and concerning c- and pN in 37.8% of the cases. An increased SUVmax significantly correlated with increased pT- and pUICC (adjusted Odds ratio 1.103; p = 0.042 and 1.126; p = 0.021, respectively). The predictive quality of an SUVmax cutoff value for detecting cervical lymph node metastases and G was poor, as indicated by the low AUC values from the ROC analysis. No correlations were found between SUVmax and ENE, Pn-, L-, and V-status. A strong correlation was found between SUVmax and tumor thickness with an adjusted coefficient of 1.034 (p = 0.01).

CONCLUSION

The predictive value of 18F-FDG-PET/CT and SUVmax on histopathological tumor classification and parameters appears limited.

CLINICAL RELEVANCE

18F-FDG-PET/CT can not unreservedly be recommended for primary OSCC staging. There is an urgent need to specify its indications in detail further.

Development and validation of accelerated failure time model for cause-specific survival and prognostication of oral squamous cell carcinoma: SEER data analysis

BACKGROUND

Oral Squamous Cell Carcinoma is the most prevalent malignancies affecting the oral cavity. Despite progress in studies and treatment options its outlook remains grim with survival prospects greatly affected by demographic and clinical factors. Precisely predicting survival rates and prognosis plays a role in making treatment choices for the best achievable overall health outcomes.

OBJECTIVE

To develop and validate an accelerated failure time model as a predictive model for cause-specific survival and prognosis of Oral Squamous Cell Carcinoma patients and compare its results to the traditional Cox proportional hazard model.

METHOD

We screened Oral cancer patients diagnosed with Squamous Cell Carcinoma from the Surveillance Epidemiology and End Results (SEER) database between 2010 and 2020. An accelerated failure time model using the Type I generalized half logistic distribution was used to determine independent prognostic factors affecting the survival time of patients with oral squamous carcinoma. In addition, accelerated factors were estimated to assess how some variables influence the survival times of the patients. We used the Akaike Information Criterion, Bayesian Information Criterion to evaluate the model fit, the area under the curve for discriminability, Concordance Index (C-index) and Root Mean Square Error and calibration curve for predictability, to compare the type I generalized half logistic survival model to other common classical survival models. All tests are conducted at a 0.05 level of significance.

RESULTS

The accelerated failure time models demonstrated superior effectiveness in modeling (fit and predictive accuracy) the cause-specific survival (CSS) of oral squamous cell carcinoma compared to the Cox model. Among the accelerated failure time models considered, the Type I generalized half logistic distribution exhibited the most robust model fit, as evidenced by the lowest Akaike Information Criterion (AIC = 27370) and Bayesian Information Criterion (BIC = 27415) values. This outperformed other parametric models and the Cox Model (AIC = 47019, BIC = 47177). The TIGHLD displayed an AUC of 0.642 for discrimination, surpassing the Cox model (AUC = 0.544). In terms of predictive accuracy, the model achieved the highest concordance index (C-index = 0.780) and the lowest root mean square error (RMSE = 1.209), a notable performance over the Cox model (C-index = 0.336, RMSE = 6.482). All variables under consideration in this study demonstrated significance at the 0.05 level for CSS, except for race and the time span from diagnosis to treatment, in the TIGHLD AFT model. However, differences emerged regarding the significant variations in survival times among subgroups. Finally, the results derived from the model revealed that all significant variables except chemotherapy, all TNM stages and patients with Grade II and III tumor presentations contributed to the deceleration of time to cause-specific deaths.

CONCLUSIONS

The accelerated failure time model provides a relatively accurate method to predict the prognosis of oral squamous cell carcinoma patients and is recommended over the Cox PH model for its superior predictive capabilities. This study also underscores the importance of using advanced statistical models to improve survival predictions and outcomes for cancer patients.

Association between the Processed Dietary Pattern and Tumor Staging in Patients Newly Diagnosed with Head and Neck Squamous Cell Carcinoma

PURPOSE

This study aimed to assess the association between dietary patterns and tumor staging and the degree of cell differentiation in patients with head and neck squamous cell carcinoma (HNSCC).

METHODS

This cross-sectional study included 136 individuals newly diagnosed with different stages of HNSCC, aged 20- to 80 years-old. Dietary patterns were determined by principal component analysis (PCA), using data collected from a food frequency questionnaire (FFQ). Anthropometric, lifestyle, and clinicopathological data were collected from patients' medical records. Disease staging was categorized as initial stage (stages I and II), intermediary (stage III), and advanced (stage IV). Cell differentiation was categorized as poor, moderate, or well-differentiated. The association of dietary patterns with tumor staging and cell differentiation was evaluated using multinomial logistic regression models and adjusted for potential confounders.

RESULTS

Three dietary patterns, "healthy," "processed," and "mixed," were identified. The "processed" dietary pattern was associated with intermediary (odds ratio (OR) 2.47; 95% confidence interval (CI) 1.43-4.26; p = 0.001) and advanced (OR 1.78; 95% CI 1.12-2.84; p = 0.015) staging. No association was found between dietary patterns and cell differentiation.

CONCLUSION

A high adherence to dietary patterns based on processed foods is associated with advanced tumor staging in patients newly diagnosed with HNSCC.

P-Cadherin and WNT5A expression in assessment of lymph node metastasis in oral squamous cell carcinoma

BACKGROUND

Oral cancer progression is a multi-step process in which adhesion molecules play a pivotal role in the development of recurrent, invasive, and distant metastasis. The aim of this study was to adopt prognostic biomarkers to assess the lymph node metastasis of OSCC that will facilitate in deciding the treatment modality by the surgeons.

OBJECTIVES

The objectives of the study were to assess the biological behaviour of OSCC by correlating the expression levels of P-Cadherin and WNT5A immunohistochemically.

METHODS

A total of 60 selected OSCCs cases (lymph node metastasis n = 30, non-metastatic n = 30) and 10 normal healthy controls were quantitatively and qualitatively analysed by immunohistochemistry for P-Cadherin and WNT5A. A survival analysis was also performed.

RESULTS

The expression levels of P-Cadherin and WNT5A in OSCC groups were statistically significant between metastatic and non-metastatic groups (p < 0.001). P-Cadherin and WNT5A expression in metastatic (lymph node metastasis) and non-metastatic cases showed a significant correlation coefficient of 0.753 at (p < 0.01). The present study also found that the aberrant expression (high) of P-Cadherin was associated with diminished survival of patients with metastatic OSCC.

CONCLUSION

The present study demonstrated the aberrant expression of P-Cadherin and WNT5A could serve as important prognosticator in OSCC.

CLINICAL RELEVANCE

P-Cadherin and WNT5A could be used as significant predictors of disease outcome.

Interleukin-1beta and Caspase-3 expression serve as independent prognostic markers for metastasis and survival in oral squamous cell carcinoma

BACKGROUND

The Indian subcontinent has the highest incidence and prevalence of oral squamous cell carcinoma (OSCC). Inflammation and apoptosis are two emerging hall marks of cancer that might play a significant role in tumorigenesis and metastasis. Concurrent expression of proinflammatory cytokine (IL-1β) and executioner caspase (Caspase-3) in same OSCC tissue samples has not been reported in an Indian population.

OBJECTIVES

The present study aimed to evaluate the immunohistochemical expression of IL-1β and Caspase-3 in same OSCC tissue samples with clinicopathological correlation and survival analysis in Indian population.

METHODS

A retrospective study was conducted utilizing 40 formalin fixed paraffin embedded histologically diagnosed cases of OSCC comprising of 20 metastatic OSCC and 20 non-metastatic OSCC.

RESULTS

Increased expression of IL-1β and Caspase-3 were observed in metastatic OSCC. Correlation of expression of IL-1β and Caspase-3 with clinicopathological parameters revealed a significant association between these markers and staging, nodal status and site of the lesion.

CONCLUSION

Over expression of IL-1β and Caspase-3 was associated with advanced stage and poor survival of the patient. IL-1β overexpression showed significantly lower disease-free survival and disease specific survival as well. Overexpression of IL-1β and Caspase-3 in incisional OSCC biopsies could be considered for predicting metastasis and survival outcome.