Oral Squamous Cell Carcinoma Frequency in Young Patients from Referral Centers Around the World

Genetic analysis of mixed lineage kinase domain-like pseudokinase (MLKL) in oral squamous cell carcinoma: A comparative evaluation between young and old patients

BACKGROUND

Oral squamous cell carcinoma (OSCC) is characterized by dysregulation of multiple cell signaling pathways, including the necroptotic pathway. Recently, the incidence of OSCC is increasing among the young population (below the age of 40 years). These patients exhibit differences in the pathobiological characteristics and treatment response compared to the older cohorts. There is a notable lack of research exploring the role of necroptotic proteins in younger OSCC patients.

AIM

To investigate the expression of Mixed Lineage Kinase domain Like Pseudokinase (MLKL), a key necroptotic protein, in young and old patients with OSCC.

METHODOLOGY

The study included sixty histopathologically confirmed cases of OSCC, categorized into two groups; Group I - 30 patients aged > 40 years and Group II - 30 patients aged ≤ 40 years. Each of these groups consisted of 10 cases each of well differentiated, moderately differentiated and poorly differentiated OSCC. The samples were evaluated for the MLKL gene expression using Real time PCR and the results were analyzed using the 2-ΔΔCT method.

RESULTS

The real-time PCR analysis showed a 31 % decrease in MLKL gene expression in the younger age group (Group II) compared to the older group. A decrease of 40 % in WDSCC, 67 % in MDSCC, and 38 % in PDSCC was observed in the younger group compared to the older age group.

CONCLUSION

Our findings suggest age-related differences in necroptotic cell death regulation through MLKL, with decreased MLKL expression observed in younger patients compared to older patients. Modulating necroptotic cell death pathways in OSCC can promote switching between different cell death pathways and provide effective therapeutic strategies.

Assessing the 53-Year Epidemiological Trends of Oral Squamous Cell Carcinoma (OSCC) in Northeastern Iran

OBJECTIVES

This study aimed to assess the epidemiological trends of oral squamous cell carcinoma (OSCC) in Northeast Iran over a 53-year period.

MATERIAL AND METHODS

In this retrospective study, we obtained data on OSCC cases in Northeast Iran spanning 53 years (1970-2022), including demographic details, such as age, sex, site, and histopathological grade. Descriptive analysis was conducted, and frequencies were compared using the chi-squared test to evaluate differences between sexes, age groups, cancer sites, and histopathological grades. Additionally, we assessed the associations of each OSCC site with age, sex, and histopathological grade. Statistical significance was set at p < 0.05, with a confidence interval of 95%.

RESULTS

This study examined 13,769 cases, among which 507 were diagnosed with OSCC, accounting for 3.68% of the total cases. The mean age was 59.27 ± 14.94 years, with a significantly higher prevalence of OSCC among individuals older than 50 years (p < 0.001). There were nearly equal proportions of males and females, with the tongue being the most common site (28.4%), followed by the gingiva (26.4%) and buccal mucosa (19.5%). Grade 1 (well differentiated) OSCC was significantly more prevalent (54%) than other grades. There was a significant association between sex and tongue SCC in females (p = 0.006) and between sex and lip SCC in males (p = 0.008). Prevalence in individuals above 50 was significant for the tongue, buccal mucosa, gingiva, and lip (p = 0.001, < 0.001, < 0.001, 0.028, respectively). In the tongue, buccal mucosa, gingiva, and floor of the mouth, grade 1 was significantly more prevalent (p < 0.001).

CONCLUSIONS

Our study revealed that OSCC predominantly affects individuals older than 50 years, with nearly equal prevalence between sexes. The most commonly affected sites are the tongue and gingiva, often exhibiting grade 1 histopathological findings. Enhanced community awareness of risk factors and regular oral examinations are essential for reducing the incidence of OSCC.

Apoptosis antagonizing transcription factor expression and its validation as a potential diagnostic and prognostic biomarker in oral squamous cell carcinoma

Background

Oral squamous cell carcinoma (OSCC) is characterized by a high degree of malignancy and poor prognosis. This study aimed to investigate the expression of apoptosis antagonizing transcription factor (AATF) in OSCC, examine its correlation with clinicopathological features, assess its prognostic implications, and explore its potential role in OSCC progression.

Methods

Expression profiles and clinical data of OSCC patients were obtained from The Cancer Genome Atlas (TCGA). Immunohistochemical analysis on tissue microarrays was performed to assess AATF expression in OSCC. Functional enrichment analyses were conducted to identify potential signaling pathways and biological functions associated with AATF. Logistic regression analyses were employed to evaluate the relationship between AATF expression and clinicopathological features. Immune cell infiltration was assessed using single-sample gene set enrichment analysis (ssGSEA). The prognostic value of AATF was determined using Kaplan-Meier and Cox regression analyses. A nomogram was developed to predict overall survival (OS) rates at one, three-, and five years post-cancer diagnosis. Validation of AATF expression was performed using quantitative real-time PCR (qRT-PCR).

Results

AATF was significantly overexpressed in OSCC, and high AATF expression correlated with adverse clinicopathological features, including histologic grade and lymph node metastasis. Functional enrichment analysis revealed several enriched pathways, including epidermis development, immunoglobulin complex, antigen binding and IL-17 signaling pathway. Notably, AATF overexpression was negatively correlated with the infiltration levels of mast cells, interdigitating dendritic cells and Th 17 cells. High AATF expression significantly predicted poorer overall survival (OS) and disease-specific survival (DSS). Multivariate Cox analysis confirmed AATF as an independent negative prognostic marker of OS. Validation via qRT-PCR confirmed the overexpression of AATF in OSCC tissues.

Conclusion

Elevated expression of AATF in OSCC correlates with adverse clinicopathological features and negatively impacts immune cell infiltration. High AATF levels serve as an independent marker of poor OS and DSS. These findings support AATF as a valuable prognostic biomarker and a potential therapeutic target in OSCC, warranting further investigation.

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.

Clinicopathologic characteristics of young patients with lip squamous cell carcinoma: a retrospective study

BACKGROUND

This retrospective study investigates the clinicopathological features and outcomes of young and elderly patients diagnosed with lip squamous cell carcinoma (LSCC).

MATERIAL AND METHODS

Data from LSCC patients from Dr. Luiz Antonio Hospital in Natal, Brazil (2000-2015) were analyzed, grouping individuals below 40 and above 60 years old. Demographics, lifestyle habits, clinicopathologic characteristics, and treatment outcomes were examined using descriptive statistics, Chi-square and Fisher's tests, and Kaplan-Meier survival analysis.

RESULTS

A total of 47 patients was analyzed, being 20 younger and 27 older, finding significant age-related differences (p = < 0.0001). Although in both groups the tumor was more common in males, older patients had a higher rate of females (29.6%) (p=0.0358) and smoking (70.4%) (p = 0.0043) and underwent more modalities of treatments (p = 0.0027). There were no significant differences in the other analyzed clinicopathologic factors, and survival rates did not differ significantly, though younger patients showed slightly better survival metrics in univariate analysis.

CONCLUSIONS

LSCC exhibits some distinct clinicopathological features across different age groups, with significant differences in treatment modalities and progression rates. Age-specific approaches may be required to optimize treatment outcomes.

Oral cancer in young adults: incidence, risk factors, prognosis, and molecular biomarkers

Oral cavity squamous cell carcinoma (OCSCC) predominantly affects the tongue and the floor of the mouth, primarily in patients over 50 years of age. Incidence and mortality rates vary significantly worldwide, influenced by geographic areas and demographic characteristics. Epidemiological studies revealed an increase in incidence of OCSCC among young adults (YA) <44 years old. This narrative review, provides updated information on the incidence, risk factors, and prognosis of YA-OCSCC using data published from 2018 to 2023 from different geographic locations. The studies indicate that the incidence of YA-OCSCC in Asia is approximately twice that in the US and that the incidence is strongly linked to risk factors such as betel quid chewing, tobacco use, and high alcohol consumption. The prognosis for YA-OCSCC, compared to that in older patients, shows similar or better overall survival, even in cases with relapses, but worse 5-year disease-free survival, despite receiving similar treatments. Consequently, a concerted effort is crucial to raise awareness about the cessation of tobacco and areca nut use, alcohol control, and the promotion of healthy lifestyle behaviors. Recent molecular data on YA-OCSCC suggests a potential profile characterized by epidermal growth factor receptor overexpression, low tumor mutation burden and an attenuated immune response. Upon confirmation in larger cohorts of YA-OCSCC patients from different geographical areas, the validated markers could aid in selecting tailored treatments.

Enhancing Oral Squamous Cell Carcinoma Detection Using Histopathological Images: A Deep Feature Fusion and Improved Haris Hawks Optimization-Based Framework

Oral cancer, also known as oral squamous cell carcinoma (OSCC), is one of the most prevalent types of cancer and caused 177,757 deaths worldwide in 2020, as reported by the World Health Organization. Early detection and identification of OSCC are highly correlated with survival rates. Therefore, this study presents an automatic image-processing-based machine learning approach for OSCC detection. Histopathological images were used to compute deep features using various pretrained models. Based on the classification performance, the best features (ResNet-101 and EfficientNet-b0) were merged using the canonical correlation feature fusion approach, resulting in an enhanced classification performance. Additionally, the binary-improved Haris Hawks optimization (b-IHHO) algorithm was used to eliminate redundant features and further enhance the classification performance, leading to a high classification rate of 97.78% for OSCC. The b-IHHO trained the k-nearest neighbors model with an average feature vector size of only 899. A comparison with other wrapper-based feature selection approaches showed that the b-IHHO results were statistically more stable, reliable, and significant (p < 0.01). Moreover, comparisons with those other state-of-the-art (SOTA) approaches indicated that the b-IHHO model offered better results, suggesting that the proposed framework may be applicable in clinical settings to aid doctors in OSCC detection.

The Impact of Oral Microbiome Dysbiosis on the Aetiology, Pathogenesis, and Development of Oral Cancer

Oral squamous cell carcinoma (OSCC) is the most common head and neck cancer. Although the oral cavity is an easily accessible area for visual examination, the OSCC is more often detected at an advanced stage. The global prevalence of OSCC is around 6%, with increasing trends posing a significant health problem due to the increase in morbidity and mortality. The oral cavity microbiome has been the target of numerous studies, with findings highlighting the significant role of dysbiosis in developing OSCC. Dysbiosis can significantly increase pathobionts (bacteria, viruses, fungi, and parasites) that trigger inflammation through their virulence and pathogenicity factors. In contrast, chronic bacterial inflammation contributes to the development of OSCC. Pathobionts also have other effects, such as the impact on the immune system, which can alter immune responses and contribute to a pro-inflammatory environment. Poor oral hygiene and carbohydrate-rich foods can also increase the risk of developing oral cancer. The risk factors and mechanisms of OSCC development are not yet fully understood and remain a frequent research topic. For this reason, this narrative review concentrates on the issue of dysbiosis as the potential cause of OSCC, as well as the underlying mechanisms involved.

Oral leukoplakia and erythroplakia in young patients: a southern Brazilian multicenter study

The objective of the present study was to investigate the frequency of oral leukoplakia and oral erythroplakia among young patients from three Brazilian reference centers in Oral and Maxillofacial Pathology. A retrospective study was carried out from 2011 to 2021 on 861 patients diagnosed with oral leukoplakia and oral erythroplakia. Demographic and clinicopathological data were evaluated. Fisher's exact test was used to evaluate the association among sex, age, anatomical location, and histopathological diagnosis. A total of 83 (9.64%) cases involved young patients (aged <40 years). Among these, biopsy records were included in 31 (37.34%) cases, all of which received a clinical diagnosis of oral leukoplakia. Seventeen (54.84%) patients were female, mostly in their fourth decade of life (n = 22/70.97%), and their mean age at diagnosis was 32.61(± 5.21) years. Among informed cases, seven (22.58%) patients were smokers. The lateral border of the tongue (n = 9/29.03%) was the most affected site. In 13 (41.94%) cases, oral leukoplakias showed a homogeneous appearance. The mean size of the lesions was 1.47 cm (0.2-3.0 cm) and the mean time of disease progression was 64.37 (± 65.90) months. The histopathological analysis showed that 11 cases (35.48%) exhibited some degree of epithelial dysplasia. Acanthosis and/or hyperkeratosis were observed in 20 cases (64.52%). No significant associations were observed between sex and anatomical location, age and anatomical location, nor between sex and histological diagnosis (p > 0.05). Oral leukoplakia and oral erythroplakia are uncommon diseases in young patients. In this population, oral leukoplakia shows a slight predilection for women aged between 30 and 39 years.

Genetic and epigenetic landscape of early-onset oral squamous cell carcinoma: Insights of genomic underserved and underrepresented populations

Oral squamous cell carcinoma (OSCC) has a poor prognosis and the treatment employed generates significant physical deformity in patients. In recent years, an increase in the incidence of cases of OSCC has been observed in adult patients up to 45 years old in several genetic underrepresented and underserved countries. The increase in OSCC cases in young people is very relevant because it shows that OSCC does not make exceptions and hereditarily must play an important role. This fact has not been associated with an evident biological basis, and a large majority of these patients do not present the classic principal risk factors association. OSCC is the result of accumulation of genetic and epigenetic alterations and this information is still fragmented in the literature, mainly in the young group. Conducting studies with a comprehensive analysis of genetic and epigenetic data is crucial, to provide greater understanding of the underlying biology of OSCC, because this information can be decisive to determine targets for therapeutic treatment. We review the main germline and somatic aspects of genetic and genomic variation in OSCC considering the absence of genomic data from developing countries such as Chile and the rest of Hispano-America.

Insights into incipient oral squamous cell carcinoma: a comprehensive south-american study

BACKGROUND

To describe demographic and clinicopathological aspects of a South-American cohort of incipient oral squamous cell carcinoma patients.

MATERIAL AND METHODS

A cross-sectional, observational study was performed to assess demographic and clinicopathological characteristics of incipient oral squamous cell carcinoma patients from 6 South-American institutions.

RESULTS

One hundred and seven patients within the histopathological spectrum of incipient oral squamous cell carcinoma (in-situ and microinvasive) were included. Fifty-eight (54.2%) patients were men with a mean age of 60.69 years. Forty-nine (45.8%) and thirty-nine (36.5%) patients had history of tobacco and alcohol use, respectively. Clinically, most of the lesions were plaques (82.2%), ≥ 2 cm in extension (72%), affecting the lateral border of the tongue (55.1%), and soft palate (12.1%) with a mixed (white and red) appearance. Eighty-two (76.7%) lesions were predominantly white and 25 (23.3%) predominantly red.

CONCLUSIONS

To the best of our knowledge, this is the largest cohort of incipient oral squamous cell carcinoma patients, which raises awareness of clinicians' inspection acuteness by demonstrating the most frequent clinical aspects of this disease, potentially improving oral cancer secondary prevention strategies.

A Retrospective Analysis of the Clinicopathological Profile of Oral Squamous Cell Carcinoma in Tobacco and Non-tobacco Users: Highlighting the Significance of Chronic Mechanical Irritation

BACKGROUND AND AIM

Oral squamous cell carcinoma (OSCC) is among the leading top three cancers in India. However, recent literature has shown an increase in the rise of oral cancer in younger individuals without any history of tobacco-related habits. Chronic mucosal irritation (CMI) has been noted to have a substantial impact on the development and etiology of OSCC. With the shift in the trend, it is imperative to observe and monitor alterations associated with its etiological factors. The study aims to evaluate the prevalence and clinical characteristics of OSCC patients and the association of these parameters in cases with and without tobacco usage.

METHODOLOGY

A retrospective study spanning a period of 10 years was done on histopathologically diagnosed cases of OSCC. Various clinicopathological characteristics were collected from patient records, including demographic features, tobacco-related habits, including tobacco chewing and smoking, clinical presentation, anatomic sites, and histopathological grading based on the inclusion and exclusion criteria. The data were tabulated to Microsoft Excel (Microsoft Corporation, Redmond, WA), and descriptive statistics analysis and chi-square test of significance were applied to the data using IBM SPSS Statistics (version 29.0.2; IBM Corp., Armonk, NY). The study correlated the epidemiologic behavior of OSCC with age, gender, site, and tobacco-related habits.

RESULTS

This study included a sample size of 204 (72 females & 132 males). Tobacco-related habit-associated cases were 98 (48.5%) and without tobacco habits were 61 cases (29.6%). Etiology associated with CMI emerged to be a significant tooth-related factor. Out of 72 females, 32 (44.4%) of the females were without habit. OSCC caused by trauma from CMI was analyzed in 40 cases (19.6%) and 22 (55%) were females. The majority of lesions (76 (37.4%) cases) presented on the lateral border of the tongue. Among the OSCC patients with a history of chronic mechanical irritation, 37 (48.7%) cases were observed to be specifically on the lateral border of the tongue.

CONCLUSION

These 10-year data will generate awareness about the disease pattern occurring within a community and provide an overview of the prerequisite of considering CMI as an etiological factor for the development of OSCC without the association of tobacco-related habits.

PI3K/AKT Signaling Pathway Mediated Autophagy in Oral Carcinoma - A Comprehensive Review

Oral cancer is the most heterogeneous cancer at clinical and histological levels. PI3K/AKT/mTOR pathway was identified as one of the most commonly modulated signals in oral cancer, which regulates major cellular and metabolic activity of the cell. Thus, various proteins of PI3K/AKT/mTOR pathway were used as therapeutic targets for oral cancer, to design more specific drugs with less off-target toxicity. This review sheds light on the regulation of PI3K/AKT/mTOR, and its role in controlling autophagy and associated apoptosis during the progression and metastasis of oral squamous type of malignancy (OSCC). In addition, we reviewed in detail the upstream activators and the downstream effectors of PI3K/AKT/mTOR signaling as potential therapeutic targets for oral cancer treatment.

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.

Oral cancer and oral potentially malignant disorders in patients with Fanconi anemia - A systematic review

The purpose of the present study was to perform a systematic review focusing on oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMD) in Fanconi anemia (FA) individuals. Electronic searches were undertaken in five databases supplemented by manual scrutiny and gray literature. Case reports and/or cases series were included. The searches yielded 55 studies describing 112 cases of OSCC (n = 107) and/or OPMD (n = 5) in FA individuals. The mean age at diagnosis of OSCC/OPMD was 27.1 (±9.6) years, and females (51.8 %) were slightly more affected. Ulcer (n = 37) or mass (n = 25) were described as clinical presentations for OSCC and OPMD. White lesions (n = 4) were the most common manifestation in OPMD. Tongue (47.2 %) was the most frequent location. Sixty-one (54.5 %) individuals underwent HSCT. Surgical resection (n = 75) was the main treatment adopted. The estimated rate of OPMD malignant transformation was 1.8 % and recurrences following OSCC excision occurred in 26.8 % of individuals. Overall, at 60 months of follow-up, the probability of survival fell to 25.5 % and at 64 months the probability of recurrence increased to 63.2 %. The present data support the need for strict surveillance of patients with FA, even in the absence of OPMD, for early OSCC detection and reduction of mortality.

Non-Habit-Related Oral Squamous Cell Carcinoma: A Review

Oral squamous cell carcinoma (OSCC) is a serious and potentially life-threatening condition that can have a profound impact on an individual's health and well-being. Its etiology is commonly known to be habit induced, such as tobacco consumption, smoking, or alcohol abuse. Apart from these etiologies, certain factors that lead to OSCC are also present but are less frequently encountered in hospitals and clinics. However, these non-habitual factors, with their pathogenesis, can lead to OSCC, which may be confusing to certain medical practitioners. This article discusses the various non-habitual causes that can lead to OSCC, as well as their pathophysiology, molecular expression, and related indicators and prognostic factors.

Gene therapy as a treatment of oral cancer: An insight

Oral cancer or oral squamous cell carcinoma comprises more than three-fourth of all the malignant neoplasms of the oral cavity. Worldwide, it is the 18th most common malignancy. The patients suffering from cancer usually remains immune to the standard therapies such as surgical resection of tumours, radiotherapy and chemotherapy; however, there can be probabilities of chronic and acute toxicities and secondary malignancies as well. Recently, gene therapy has been introduced in the arena of biomedicine to improve the treatment modality for oral malignant and potentially malignant disorders. It replaces the defective gene followed by repairing by a therapeutic gene. Gene therapy can attack cancerous cells without causing harmful effect to the normal tissue. It is useful to cope with the relapse of diseases and as a synergetic treatment. The present article reviewed the types of gene therapy, modes of delivery of the therapeutic genes and different techniques used along with pros and cons of gene therapy.