The World Cancer Report and the burden of oral cancer

The Use of Immune Regulation in Treating Head and Neck Squamous Cell Carcinoma (HNSCC)

Immunotherapy has emerged as a promising new treatment modality for head and neck cancer, offering the potential for targeted and effective cancer management. Squamous cell carcinomas pose significant challenges due to their aggressive nature and limited treatment options. Conventional therapies such as surgery, radiation, and chemotherapy often have limited success rates and can have significant side effects. Immunotherapy harnesses the power of the immune system to recognize and eliminate cancer cells, and thus represents a novel approach with the potential to improve patient outcomes. In the management of head and neck squamous cell carcinoma (HNSCC), important contributions are made by immunotherapies, including adaptive cell therapy (ACT) and immune checkpoint inhibitor therapy. In this review, we are focusing on the latter. Immune checkpoint inhibitors target proteins such as programmed cell death protein 1 (PD-1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) to enhance the immune response against cancer cells. The CTLA-4 inhibitors, such as ipilimumab and tremelimumab, have been approved for early-stage clinical trials and have shown promising outcomes in terms of tumor regression and durable responses in patients with advanced HNSCC. Thus, immune checkpoint inhibitor therapy holds promise in overcoming the limitations of conventional therapies. However, further research is needed to optimize treatment regimens, identify predictive biomarkers, and overcome potential resistance mechanisms. With ongoing advancements in immunotherapy, the future holds great potential for transforming the landscape of oral tumor treatment and providing new hope for patients.

Role of Natural Killer Cells as Cell-Based Immunotherapy in Oral Tumor Eradication and Differentiation Both In Vivo and In Vitro

Despite advancements in the field of cancer therapeutics, the five-year survival rate remains low in oral cancer patients. Therefore, the effective therapeutics are needed against oral cancer. Also, several studies including ours, have shown severely suppressed function and number of NK cells in oral cancer patients. In this review, we discuss the approach to inhibit the tumor growth and metastasis by direct killing or NK cell-mediated tumor differentiation. This review also provides an overview on supercharging NK cells using osteoclasts and probiotic bacteria, and their efficacy as cancer immunotherapeutic in humanized-BLT mice.

Landscape and the immune patterns of cuproptosis in oral squamous cell carcinoma

BACKGROUND

Oral squamous cell carcinoma is an increasingly prevalent cancer type characterized by high incidence and mortality rates. Its early detection is challenging, primarily because of the absence of early molecular markers. Cuproptosis is a novel regulatory mechanism of cell death with implications in various cancers. In this study, we aimed to study cuproptosis-related genes in oral squamous cell carcinoma to identify their prognostic value.

METHODS

By analyzing genomic, bulk RNA-seq, and single-cell RNA-seq data, we investigated 13 cuproptosis-related genes in The Cancer Genome Atlas-Oral Squamous Cell Carcinoma dataset and Gene Expression Omnibus repository (GSE172577).

RESULTS

ATP7A, ATP7B, and DLST were the most frequently mutated genes, with nine of our studied genes associated with overall survival. Single-cell analysis was conducted to identify cuproptosis-related tumor cells in oral squamous cell carcinoma, which revealed two distinct patterns based on the expression of cuproptosis-related genes. These patterns exhibit differences in genetic alterations and tumor immune microenvironment. Finally, we developed a cuproptosis index using a random forest algorithm based on cuproptosis pattern-related genes in which higher levels were linked to poorer prognosis.

CONCLUSION

Our findings provide valuable insights into the mechanisms underlying oral squamous cell carcinoma-associated cuproptosis.

NLRP3 inflammasome-induced pyroptosis in digestive system tumors

Programmed cell death (PCD) refers to cell death in a manner that depends on specific genes encoding signals or activities. PCD includes apoptosis, pyroptosis, autophagy and necrosis (programmed necrosis). Among these mechanisms, pyroptosis is mediated by the gasdermin family and is accompanied by inflammatory and immune responses. When pathogens or other danger signals are detected, cytokine action and inflammasomes (cytoplasmic multiprotein complexes) lead to pyroptosis. The relationship between pyroptosis and cancer is complex and the effect of pyroptosis on cancer varies in different tissue and genetic backgrounds. On the one hand, pyroptosis can inhibit tumorigenesis and progression; on the other hand, pyroptosis, as a pro-inflammatory death, can promote tumor growth by creating a microenvironment suitable for tumor cell growth. Indeed, the NLRP3 inflammasome is known to mediate pyroptosis in digestive system tumors, such as gastric cancer, pancreatic ductal adenocarcinoma, gallbladder cancer, oral squamous cell carcinoma, esophageal squamous cell carcinoma, in which a pyroptosis-induced cellular inflammatory response inhibits tumor development. The same process occurs in hepatocellular carcinoma and some colorectal cancers. The current review summarizes mechanisms and pathways of pyroptosis, outlining the involvement of NLRP3 inflammasome-mediated pyroptosis in digestive system tumors.

Chemoprevention of oral cancer: A review and future perspectives

BACKGROUND

Oral cancer causes significant morbidity and mortality. Chemoprevention utilizes medication or natural compounds to reverse oral premalignant lesions and to prevent second primary tumors.

METHODS

A comprehensive PubMed database and Cochrane Library search from 1980 to 2021 was performed using the keywords "leukoplakia," "oral premalignant lesion," and "chemoprevention."

RESULTS

Chemopreventive agents included retinoids, carotenoids, cyclooxygenase inhibitor, herbal extracts, bleomycin, tyrosine kinase inhibitors, metformin, and immune checkpoint inhibitors. Although some agents demonstrated effect in reducing premalignant lesions and preventing second primary tumors, the results among different studies were highly variable.

CONCLUSIONS

The results of different trials, albeit inconsistent, provided substantial information for future studies. In the era of personalized medicine, future studies will focus on identifying specific biomarkers and molecular profile to monitor and to prevent malignant transformation. Larger trials are warranted to validate the effect of chemopreventive agents.

Survival Analysis of Oral Squamous Cell Carcinoma Patients Attending Tertiary Care Centre of North India

The cumulative survival for all stages in oral squamous cell cancers (OSCC) in the world remains poor despite the advances in management; hence, we conducted this study to evaluate the survival outcomes. This is a retrospective review and analysis of treatment, follow-up and survival records of 249 OSCC patients treated in our department from April 2010 to April 2014. Telephonic interviews were conducted for survival details for some patients who had not reported. Survival analysis was done using the Kaplan-Meier analysis, comparisons were done using log-rank test and multivariate analysis was conducted using the Cox proportional hazard model to find different variables (site, age, sex, stage and treatment) affecting overall survival (OS)/disease-free survival (DFS). Two-year and 5-year DFS for OSCC were observed to be 72.3% and 58.3% with mean survival of 63.17 months (95% CI: 58.342-68.002). Similarly, OS at 2 years and 5 years were 84.3% and 55.9% with mean survival of 65.143 months (95% CI: 60.143-69.601). Tumour site, patient age, stage of disease and treatment modality had a statistically significant hazardous effect on the overall and disease-free survival rates. The significant influence of age, site of tumour, stage of disease and modality of treatment required based on the clinic-pathologic risk factors on prognosis emphasizes the importance of early diagnosis through regular screening and early treatment which can be ensured with early referral, high clinical suspicion and awareness at the point of primary/secondary care.

SCARA5 inhibits oral squamous cell carcinoma via inactivating the STAT3 and PI3K/AKT signaling pathways

Oral squamous cell carcinoma (OSCC) is a common tumor in the world. Despite the rapid development of medical care, OSCC is also accompanied by high incidence and mortality every year. Therefore, it is still necessary to continuously develop new methods or find new targets to treat OSCC. Previous research showed that scavenger receptor class A member 5 (SCARA5) was one of the potential biomarkers of OSCC, and its expression is significantly low in OSCC. This study aimed to explore the role and related molecular mechanisms of SCARA5 in OSCC. In this study, we found that the SCARA5 expression was lower in CAL-27 and SCC-9 cells than that in human normal oral epithelial keratinocytes. SCARA5 overexpression significantly inhibited cell proliferation and induced apoptosis of CAL-27 and SCC-9 cells. In addition, SCARA5 repressed OSCC cell epithelial-mesenchymal transformation (EMT), evidenced by increased E-cadherin expression and reduced N-cadherin expression. Finally, we found that SCARA5 could suppress STAT3, PI3K, and AKT phosphorylation. Therefore, SCARA5 was related to STAT3 and PI3K/AKT signaling pathways in OSCC. In conclusion, SCARA5 inhibited the proliferation and EMT and induced the apoptosis of OSCC cells through the inhibition of STAT3 and PI3K/AKT signaling pathways, thereby exerting a tumor suppressor effect.

Impact of Depth of Invasion (According to Layer) on Lymph Node Metastasis in Buccal Mucosa Cancers

(1) To study layer of invasion as predictor of cervical lymph node metastasis. (2) To decide a cut off depth according to layer of invasion for neck dissection. It is a prospective study with sample size of 220 patients at tertiary care hospital with previously untreated operable buccal mucosa carcinoma over period of 21 months. The factors considered under the study were Tumor layer of invasion, lymph node metastasis, Ultrasonography doppler neck, CT scan and gender. Wide excision of the lesion and reconstruction was done. Histopathological analysis of resected specimen were recorded as part of data collection for all the cases. Quantitative data represented using Mean ± SD (Standard Deviation) and median and interquartile range compared using Chi square test. Standard principles of univariate analysis was used according to statistical methods. Depth when measured according to layer of invasion, was significantly associated with lymph node metastasis with 89% of the muscle as layer of invasion being Lymph node positive (p = 0.009). There is 1.39 times chances of lymph nodal metastasis in patients with muscle invasion as compared to submucosal invasion. Tumour layer of invasion plays important role in predicting chances of nodal metastasis in clinically N0 neck in buccal mucosa cancer. According to the study, we should electively proceed with ipsilateral lymph node dissection once the layer of tumour invasion is muscle. This study is limited by sample size and short duration of one year and nine months.

Mobile Health (mHealth) Technology in Early Detection and Diagnosis of Oral Cancer-A Scoping Review of the Current Scenario and Feasibility

Objective

Oral cancer is one of the most common types of cancer with dreadful consequences. But it can be detected early without much expensive equipment. Screening and early detection of oral cancer using Mobile health (mHealth) technology are reported due to the availability of the extensive network of mobile phones across populations. Therefore, we aimed to explore the existing literature regarding mHealth feasibility in the early detection of oral cancer. Materials and Method. An extensive search was conducted to explore the literature on the feasibility of mobile health for early oral cancer. Clinical studies reporting kappa agreement between on-site dentists and offsite health care workers/dentists in the early detection of oral cancer were included in this review. Studies describing the development of a diagnostic device, app development, and qualitative interviews among practitioners trained in using mobile health were also included in this review for a broader perspective on mHealth.

Results

While most of the studies described various diagnostic accuracies using mHealth for oral cancer early detection, few studies reported the development of mobile applications, novel device designs for mHealth applications, and the feasibility of a few mHealth programs for early oral cancer detection. Community health workers equipped with a mobile phone-based app could identify “abnormal” oral lesions. Overall, many studies reported high sensitivity, specificity, and Kappa value of agreement. Effectiveness, advantages, and barriers in oral cancer screening using mHealth are also described.

Conclusion

The overall results show that remote diagnosis for early detection of oral cancer using mHealth was found useful in remote settings.

Tumor microenvironment and immunotherapy of oral cancer

Oral cancer is one of the most common malignant tumors of the head and neck, not only affects the appearance, but also affects eating and even endangers life. The clinical treatments of oral cancer mainly include surgery, radiotherapy, and chemotherapy. However, unsatisfactory therapeutic effect and toxic side effects are still the main problems in clinical treatment. Tumor microenvironment (TME) is not only closely related to the occurrence, growth, and metastasis of tumor but also works in the diagnosis, prevention, and treatment of tumor and prognosis. Future studies should continue to investigate the relationship of TME and oral cancer therapy. This purpose of this review was to analyze the characteristics of oral cancer microenvironment, summarize the traditional oral cancer therapy and immunotherapy strategies, and finally prospect the development prospects of oral cancer immunotherapy. Immunotherapy targeting tumor microenvironment is expected to provide a new strategy for clinical treatment of oral cancer.

Clinicopathological characteristics predicting advanced stage and surgical margin invasion of oral squamous cell carcinoma: A single‑center study on 10 years of cancer registry data

The incidence profile of oral squamous cell carcinoma (OSCC) has not previously been comprehensively reported in Indonesia. The present study aimed to identify clinicopathological characteristics of patients with OSCC according to sex and age, to analyze histological differentiation patterns specific to tumor subsites, to highlight the role of lymphovascular invasion (LVI) in metastasis, and to develop a model to predict advanced stage and margin invasion. A retrospective cross-sectional study was performed using 581 medical records and pathological specimens from cancer registry data in the Dr Cipto Mangunkusumo Hospital (Jakarta, Indonesia), between January 2011 and December 2020. Clinicopathological characteristics were analyzed using parametric and non-parametric tests. Multivariate logistic regression analyses were performed for eligible parameters, identified using bivariate analysis, to predict advanced stage and margin invasion. Calibration of the prediction model was evaluated using the Hosmer-Lemeshow test, its discrimination value assessed using the receiver operating characteristic and area under the receiver operating characteristic curve (AUC). Sex-specific patterns in tumor subsites and differences in clinical staging according to age were demonstrated in the patients with OSCC. The proportion of well-differentiated cases was significantly higher in most tumor subsites, except in the buccal mucosa (more moderately differentiated cases) and floor of the mouth (well and moderately differentiated cases being equal). LVI was significantly associated with nodal metastasis but not distant metastasis. Multivariate analysis demonstrated that age ≤45 years [odds ratio (OR), 2.26] and LVI (OR, 8.42) predicted patients having advanced-stage OSCC among general populations (AUC, 0.773); however, LVI (OR, 8.28) was the sole predictor of advanced stage amongst young patients (AUC, 0.737). Margin invasion was predicted solely by tumor subsite, including mouth not otherwise specified (OR, 3.04) and palate (OR, 6.13), in the general population (AUC, 0.711). Furthermore, margin invasion was predicted by the palate subsite (OR, 38.77) and LVI (OR, 11.61) in young patients (AUC, 0.762). Investigating young patients thoroughly when finding SCC in the mouth and palate, and assessing LVI, especially among young patients, is critical to prevent advanced staging and margin invasion.

Dentists Behavioral Factors Influencing Early Detection of Oral Cancer: Direct Clinical Observational Study

This study aimed to investigate the possible factors affecting dentists' behavior relating to performing oral cancer examinations as part of routine clinical examination. A total of 95 direct clinical observation sessions-utilizing an instrument consisting of 19 evidence-based observational criteria for oral cancer examinations-were observed by four calibrated dentists. Thirty-two final-year students, 32 interns, and 31 faculty members of Jazan Dental School were examined between April 9 and May 4, 2017. A descriptive analysis was conducted to investigate the frequencies/percentages of the performed observing criteria by all examiners. ANOVA and Tukey tests were carried out to investigate the difference between the examiner groups. A total number of 32 patients participated in the study, whereby each patient was examined by three different examiners from each group, as well as by the attending observer/s. Fewer than 50% of the examiners performed the clinical steps necessary for an oral cancer examination-for example, taking into account past medical history, as well as extra and intra-oral examinations. More than 90% of the examiners examined hard tissue, whereas fewer than 30% of them educated their patients about possible risk factors. A significant difference between examiner groups was found in favor of faculty members. A gap between knowledge and actual practice of oral cancer examinations was evident: majority of participants failed to perform the necessary steps for an oral cancer examination. Previous experience and confidence in performing oral cancer examination are possible explanations for the dentist's behavior toward oral cancer examination.

A high-throughput screening assay for identification of chemicals with liver tumor promoting potential using a transgenic zebrafish line

Traditional high-throughput methods for identification of chemicals with liver tumor promotion potentials are based on established cancer cell lines, and rapid and cost-effective high-throughput screening assays in whole organisms are presently lacking. In this study, a transgenic zebrafish liver cancer model was employed to develop a method that could be used to identify chemicals with liver tumor promotion effect quickly and accurately. The method consisted of three parts, including exposure preparation, exposure process and image acquisition. In brief, after chemical exposure for 7 days, 96-well plate exposure system for zebrafish larvae was assessed by microplate reader. Then, the liver cancer promoting potential chemicals were evaluated by field area and field average intensity of fluorescence. The results were further validated by conducting histopathological examination. Our data demonstrated that the high-throughput screening assay developed in this study was reproducible and could be used to rapidly screen chemicals with liver tumor promoting potentials by using tris-(2-chloropropyl)-phosphate (TDCIPP) as a positive control. Furthermore, some other positive chemicals found in previous studies and environmental compounds were assessed using the established method. Results indicated that 86.7% of the positive chemicals and five environmental compounds out of seventeen compounds could enhance liver tumor progression.

Adjunctive techniques and diagnostic aids in the early detection of oral premalignant disorders and cancer: An update for the general dental practitioners

Oral cancer (OC), a potentially fatal disease, is a major health concern across the world. It is reported to be the sixth most common cancer in the world with a disappointingly low 5-year survival rate, despite major advances in onco-medicine in the past three decades. The low 5-year-survival rate is associated with late diagnosis of the disease, while OC diagnosed at early stages enjoy a much higher 5-year-survival rate, comparatively. Although the oral cavity is one of the most easily accessible parts of the body for cancer screening, OC is typically diagnosed at later stages. The delay in diagnosis is one of the factors for the poor 5-year survival rate and high mortality and morbidity among patients. Therefore, an early diagnosis is of utmost importance. Visual and tactile examination and scalpel biopsy are still considered the gold standard for definitive diagnosis of oral potentially malignant disorder (OPMD) and OC. Nevertheless, adjunctive techniques could be employed to increase the ability to distinguish benign abnormalities from dysplastic/malignant changes. These would also aid in identifying areas of dysplasia/early OC that are not visible to the naked eye and tackle the delay in diagnosing OPMD/OC. These adjunctive tools are not a replacement for visual and tactile examination but are supplementary aids. They could be used to screen healthy patients for the presence of any occult cancerous change and evaluate the biological potential of clinically abnormal mucosal lesions, thus enabling early recognition and diagnosis which might increase survival rate and reduce mortality and treatment-associated morbidity.

Tumor necrosis factor-α induced protein 8 (TNFAIP8/TIPE) family is differentially expressed in oral cancer and regulates tumorigenesis through Akt/mTOR/STAT3 signaling cascade

BACKGROUND

Highest incidence of oral cancer is reported in India with reduced survival rate in the advanced stages due to lack of effective biomarkers. Therefore, it is essential to develop novel biomarkers for the better management of this disease. In the current study, TNFAIP8/TIPE protein family comprising of four proteins is explored for its role in oral cancer.

METHODS

IHC analysis of oral cancer TMA and Western blot analysis of tobacco treated oral cancer cells were performed to determine the differential expression of TIPE proteins in oral cancer. Further, CRISPR/Cas9-mediated gene editing was done to generate TIPE proteins' knockouts and MTT, colony formation, wound healing, cell cycle and Western blot analysis were performed to determine the effect of gene knockouts on various cancer hallmarks and the associated molecular targets of TIPE proteins.

RESULTS AND DISCUSSION

IHC results revealed that expression of TIPE, TIPE2 and TIPE3 were upregulated and TIPE1 was downregulated in oral cancer tissues compared to normal tissues. Similar results were observed upon treating oral cancer cells with tobacco carcinogens. Furthermore, knockout of TIPE or TIPE2 or TIPE3 significantly reduced the survival, proliferation, colony formation and migration of oral cancer cells whereas knockout of TIPE1 had an opposite effect. Further, TIPE, TIPE2 and TIPE3 knockout-mediated inhibition of proliferation was associated with inhibition of cell cycle progression at S or G2/M phases, and downregulation of proteins involved in cancer progression. We found that TIPE, TIPE1 and TIPE2 proteins regulate oral cancer progression through modulation of Akt/mTOR signaling cascade, whereas TIPE3 acts through an Akt-independent mTOR/STAT3 pathway.

CONCLUSION

Collectively, the TIPE proteins were proved to play significant roles in the progression of oral cancer thus warranting research and clinic attention for their therapeutic and prognostic values and raising the importance of specific targeting of TIPE proteins in cancer treatment.

Targeting the IDO-BCL2A1-Cytochrome c Pathway Promotes Apoptosis in Oral Squamous Cell Carcinoma

Purpose

Indolamine 2,3-dioxygenase (IDO) is the rate limiting enzyme of tryptophan degradation and is a negative prognostic factor in oral squamous cell carcinoma (OSCC) patients, while the underlying molecular mechanism remains unclear. This research aimed to explore the IDO expression and its biological functions in OSCC.

Materials and Methods

IDO expression was analyzed by qPCR, Western blots, and immunohistochemistry (IHC) in OSCC cell lines and tissue specimens. Tryptophan and kynurenine content were determined by UPLC-MS/MS in serum samples of OSCC patients and healthy controls. Oncomine databases and Kaplan-Meier survival analyses were used to identify the IDO expression and its correlation with OSCC prognosis. Cell counting, CCK8 assay, flow cytometry, cell cycle, and EdU incorporation assays were used to assess the effect of IDO inhibition on OSCC growth either by shRNA or the IDO-specific inhibitor (epacadostat) in vitro. An OSCC xenograft mouse model was established to verify the predicted function of IDO inhibition in vivo. Mechanistically, an 84-gene apoptosis PCR array and rescue experiment were used to characterize the underlying mechanism involved in IDO-regulated apoptosis in OSCC.

Results

IDO expression was upregulated in OSCC cell lines and tissues and was negatively correlated with OSCC progression. Lentivirus-mediated IDO knockdown and epacadostat significantly reduced viability and promoted apoptosis of OSCC cells in vitro and in vivo. The apoptosis PCR array identified BCL2 related protein A1 (BCL2A1) as the most obviously changed gene at the transcriptional level. IDO inhibition downregulated BCL2A1 expression, increased the expression and translocation of cytochrome c, thus promoted apoptosis in OSCC. Overexpression of BCL2A1 reversed the pro-apoptotic effect of IDO inhibition.

Conclusion

The present results revealed that IDO directly affect the growth of OSCC cells by regulating BCL2A1 expression. IDO and the IDO-BCL2A1-cytochrome c axis may be potential therapeutic targets for OSCC.

Malignant transformation of oral leukoplakia: Systematic review and meta-analysis of the last 5 years

OBJECTIVE

Oral leukoplakia (OL) is the most frequently encountered oral potentially malignant disorder. The aims of this systematic review are to estimate the overall malignant transformation of OL and to assess the risk factors associated with malignant transformation of OL published in the last 5 years (2015-2020).

MATERIALS AND METHODS

We performed a bibliographic search in PubMed, Scopus, Web of Science, Embase, and Cochrane databases with keywords "oral leukoplakia", "oral cancer", "oral carcinoma" and "oral squamous cell carcinoma". Meta-analysis was conducted using a random-effects model.

RESULTS

Twenty-four studies were selected, that reported a total of 16,604 patients. Malignant transformation proportion varied between 1.1% and 40.8%. Female gender, non-homogeneous clinical type, and presence of epithelial dysplasia were significantly related to MT. Other risk factors previously suggested did not show significant results.

CONCLUSIONS

The pooled proportion of malignant transformation MT was 9.8% (95% CI: 7.9-11.7). It is necessary to continue to conduct well-designed prospective clinicopathological studies on OL, using a uniform definition for OL to reduce the risk of bias for evaluating various factors associated with the MT.

Prognostic Significance of Cytoplasmic SPNS2 Expression in Patients with Oral Squamous Cell Carcinoma

Background and Objectives: Oral squamous cell carcinoma (OSCC) is a malignant disease with a particularly high incidence in Taiwan. Our objective in this study was to elucidate the involvement of sphingolipid transporter 2 (SPNS2) expression and SPNS2 protein expression in the clinicopathological indexes and the clinical outcomes of OSCC patients. Materials and Methods: Immunohistochemistry analysis was performed for SPNS2 protein expression in samples from 264 cases of OSCC. Correlations of SPNS2 expression with clinicopathological variables and patient survival were analyzed. Results: Our results revealed that the cytoplasmic protein expression of SPNS2 in OSCC tissue specimens was lower than in normal tissue specimens. Negative cytoplasmic protein expression of SPNS2 was significantly correlated with T status and stage. Kaplan-Meier survival curve analysis revealed that negative cytoplasmic SPNS2 expression was predictive of poorer overall survival of OSCC patients in stage III/IV. We also determined that low SPNS2 expression was an independent prognostic factor related to overall survival among OSCC patients in stage III/IV from univariate Cox proportional hazard models. Multivariate Cox proportional hazard models revealed that cytoplasmic SPNS2 expression, T status, lymph node metastasis, and histological grade were independent prognostic factors for survival. Conclusions: Overall, this study determined that SPNS2 protein may be a useful prognostic marker for OSCC patients and potential therapeutic target for OSCC treatment.

Young age is not a predictor of disease specific survival in oral cancer: A multi-institutional study

BACKGROUND

Over the last few decades evidence has accumulated for increasing incidence of oral cavity squamous cell carcinoma (OSCC) in a younger cohort. Prior studies examining the effect of age at diagnosis on prognosis have produced conflicting data.

METHODS

A multi-institutional cohort study was performed across 6 different sites in Australia, Canada, India and Singapore. Disease-free (DFS), overall (OS) and disease-specific (DSS) survival were analysed. The association of the number of adverse features with survival outcomes was investigated.

RESULTS

From 3179 patients, age was a significant predictor of OS with patients older than 45 years having a 66% increased risk of death (HR 1.66, 95%CI 1.33 - 2.07, p < 0.001). The number of adverse features was a significant predictor of OS with 3 or more adverse features having a 199% increased risk (HR 2.99, 95%CI 2.61-3.43. p < 0.001). The estimate effect was greater in patients ≤ 45 years (HR 3.49 vs HR 2.81). Age was not a significant predictor of DSS with similar rates of death from OSCC in multivariable models. The number of adverse features was a significant predictor of DFS with ≥ 3 adverse features having a 140% increased risk of death. The number of adverse features was a significant predictor of DSS with ≥ 3 adverse features having a 230% increased risk of disease specific death.

CONCLUSIONS

Age is not an independent predictor of disease specific mortality in OSCC. Differences in outcomes are due to the confounding effect of adverse clinicopathological features and the ability to tolerate surgery and adjuvant therapy.

Expression of invadopodia markers can identify oral lesions with a high risk of malignant transformation

Oral squamous cell carcinoma (OSCC) is the most common malignant tumor of the oral cavity and is usually preceded by a range of premalignant tissue abnormalities termed oral potentially malignant disorders. Identifying malignant transformation is critical for early treatment and consequently improved survival and decreased morbidity. Invadopodia (INV) are specialized subcellular structures required for cancer cell invasion. We developed a new method to visualize INV in keratinocytes using fluorescent immunohistochemistry (FIHC) and semi‐automated images analysis. The presence of INV was used to determine the risk of malignant transformation. We analyzed 145 formalin‐fixed, paraffin‐embedded (FFPE) oral biopsy samples from 95 patients diagnosed as nondysplastic, dysplastic, and OSCC including 49 patients whose lesions transformed to OSCC (progressing) and 46 cases that did not transform to OSCC (control). All samples were stained for Cortactin, tyrosine kinase substrate with five SH3 domains (Tks5) and matrix metallopeptidase 14 (MMP14) using FIHC, imaged using confocal microscopy and analyzed using a multichannel colocalization analysis. The areas of colocalization were used to generate an INV score. Using the INV score, we were able to identify progressing lesions with a sensitivity of 75–100% and specificity of 72–76%. A positive INV score was associated with increased risk of progression to OSCC. Our results suggest that INV markers can be used in conjunction with the current diagnostic standard for early detection of OSCC.

Fluorescence-guided resection of tumors in mouse models of oral cancer

Complete removal and negative margins are the goal of any surgical resection of primary oral cavity carcinoma. Current approaches to determine tumor boundaries rely heavily on surgeons' expertise, and final histopathological reports are usually only available days after surgery, precluding contemporaneous re-assessment of positive margins. Intraoperative optical imaging could address this unmet clinical need. Using mouse models of oral cavity carcinoma, we demonstrated that PARPi-FL, a fluorescent PARP inhibitor targeting the enzyme PARP1/2, can delineate oral cancer and accurately identify positive margins, both macroscopically and at cellular resolution. PARPi-FL also allowed identification of compromised margins based on fluorescence hotspots, which were not seen in margin-negative resections and control tongues. PARPi-FL was further able to differentiate tumor from low-grade dysplasia. Intravenous injection of PARPi-FL has significant potential for clinical translation and could aid surgeons in assessing oral cancer margins in vivo.

Prognostic value of log odds of positive lymph nodes in patients with resectable oral squamous cell carcinoma

OBJECTIVES

Log odds of positive lymph nodes (LODDS) was reported to be significantly associated with prognosis in several malignant tumors. However, few are the studies on the correlation between LODDS and overall survival (OS) in patients with oral squamous cell carcinoma (OSCC).

MATERIALS AND METHODS

A retrospective study including 233 patients with OSCC during 2009 to 2013 was conducted. We probed the correlation between clinicopathological factor, LODDS, lymph node ratio (LNR), pN and OS. The potential prognostic factor and the independent factor were calculated using univariate analysis and multivariate analysis respectively. The goodness of fit and the discriminability was analyzed with Somer's D value, Nagelkerke R2 index, and Akaike information criterion (AIC). Kaplan-Meier survival curve of OS was contrasted by log-rank test in LODDS, LNR and pN, respectively.

RESULTS

According to the X-tile, the cut-off values are -1.491 and -0.763 for LODDS, 0.024 and 0.133 for LNR. LODDS, LNR and pN were significantly correlated with OS by univariate analysis (P < 0.001). Multivariate analysis demonstrated LODDS, LNR and pN as an independent prognostic factors for OS (P < 0.01). Compared with pN and LNR models, LODDS showed the strongest predictive power. LODDS was superior to LNR and pN in predicting outcomes in patients with no positive lymph nodes and inadequate neck dissection.

CONCLUSION

LODDS would be incorporated into future N classification, which may be conducive to discern the prognosis of OSCC and make a decision of adjuvant therapy in clinical practice.

Hypermethylated PAX1 and ZNF582 genes in the tissue sample are associated with aggressive progression of oral squamous cell carcinoma

BACKGROUND

DNA methylation of paired box gene 1 (PAX1) and zinc finger 582 (ZNF582) is promising cancer biomarkers for oral squamous cell carcinoma detection. This study aims to investigate the correlation between PAX1 or ZNF582 methylation and the progression of oral squamous cell carcinoma (OSCC).

MATERIALS AND METHODS

A total of 135 OSCC cases from Peking University School and Hospital of Stomatology were enrolled in this study. Tissue specimens were collected from the lesion site and corresponding adjacent normal site. The methylation level of these two genes was evaluated in primary and recurrent OSCC group.

RESULTS

Hypermethylation of PAX1 or ZNF582 was observed in lesion sites among primary and recurrent OSCC cases. In the lesion site of primary cases, promoter methylation was observed in T3/T4 (PAX1: P = .02; ZNF582: P = .01), stage III/IV (PAX1: P = .03; ZNF582: P = .01), and bone invasion cases (PAX1: P = .02; ZNF582: P = .047). In the subgroup analysis, the correlation between hypermethylation and OSCC severity remains significant with exposure to smoking/alcohol consumption.

CONCLUSIONS

Hypermethylated PAX1 and ZNF582 can sufficiently act as biomarkers to reflect the severity or progression of OSCC.

V. A, Rana MH, Gurpur P, Skandarajah A, D’Ambrosio M, Ramanjinappa RD, Mohan SP, Raghavan N, Kandasarma U, N. S, Raghavan S, Hedne N, Koch F, Fletcher DA, Selvam S, Kollegal M, N. PB, Ladic L, Suresh A, Pandya HJ, Kuriakose MA. A smart tele-cytology point-of-care platform for oral cancer screening

Early detection of oral cancer necessitates a minimally invasive, tissue-specific diagnostic tool that facilitates screening/surveillance. Brush biopsy, though minimally invasive, demands skilled cyto-pathologist expertise. In this study, we explored the clinical utility/efficacy of a tele-cytology system in combination with Artificial Neural Network (ANN) based risk-stratification model for early detection of oral potentially malignant (OPML)/malignant lesion. A portable, automated tablet-based tele-cytology platform capable of digitization of cytology slides was evaluated for its efficacy in the detection of OPML/malignant lesions (n = 82) in comparison with conventional cytology and histology. Then, an image pre-processing algorithm was established to segregate cells, ANN was trained with images (n = 11,981) and a risk-stratification model developed. The specificity, sensitivity and accuracy of platform/ stratification model were computed, and agreement was examined using Kappa statistics. The tele-cytology platform, Cellscope, showed an overall accuracy of 84–86% with no difference between tele-cytology and conventional cytology in detection of oral lesions (kappa, 0.67–0.72). However, OPML could be detected with low sensitivity (18%) in accordance with the limitations of conventional cytology. The integration of image processing and development of an ANN-based risk stratification model improved the detection sensitivity of malignant lesions (93%) and high grade OPML (73%), thereby increasing the overall accuracy by 30%. Tele-cytology integrated with the risk stratification model, a novel strategy established in this study, can be an invaluable Point-of-Care (PoC) tool for early detection/screening in oral cancer. This study hence establishes the applicability of tele-cytology for accurate, remote diagnosis and use of automated ANN-based analysis in improving its efficacy.

Is there an association between past dental visits and the incidence of cancers of the head and neck (HN), upper aerodigestive tract (UADT), and oral cavity?

Data sources PubMed, CINAHL, and Cochrane databases.Study selection Papers reporting a primary study with any population, one or both genders specified, participants of any age, incidence of any cancer subsite of HN, and UADT reported as the health outcome, frequency of dental visits/check-ups prior to the diagnosis of one of these cancers (assessed as the exposure), and availability of sufficient data to estimate the measure of association, ie, unadjusted odds ratio (OR) along with its corresponding 95% confidence interval (CI).Data extraction and synthesis Two reviewers independently screened the title and abstract of the identified citations. Full texts of citations judged as potentially eligible were acquired by at least one of the two reviewers. Thereafter, both the reviewers used a standardised and pilot-tested form to independently screen every full text for eligibility. Methodological quality of the studies was assessed using the quality assessment tool for quantitative studies developed by the Effective Public Health Practice Project (EPHPP)Results After initial search of 1377 studies, thirty-eight articles were included in the analysis for systemic review including 32 case-control and six other design studies not limited to cross-sectional, observational, case-series, and screening. Finally, twenty-six case-control studies were included in the meta-analysis. Subgroup analyses of studies in meta-analysis showed the overall pooled estimate risk was (OR 2.01; 95% CI 1.76 to 2.30, P <0.001). The test for heterogeneity produced Tau square of 0.00, Q = 36.33, I2 = 31.76%, test for overall effect z = 9.24, (P <0.001). No publication bias was observed in the meta analysis. Conclusions Individuals with never/irregular/not frequent dental visits are more likely to be incident cases of HNCs/UADT cancers. Targeted education to alert those at risk about OCs and other HNCs, and the warning signs, and better training coupled with opportunistic oral cavity examinations by dentists could reduce the burden of this disease.

Retrospective Outcome Analysis of Buccal Mucosal and Lower Alveolar Squamous Cell Carcinoma from a High-Volume Tertiary Cancer Centre

To evaluate treatment outcome and factors affecting locoregional control and distant metastasis in buccal mucosal and lower alveolar squamous cell carcinoma. A retrospective analysis of all diagnosed cases of buccal mucosal and lower alveolar squamous cell carcinoma in patients who underwent surgical treatment in 2011 was included from the data base. The patients were analysed for their habits, trismus, skin and bone involvement, neck nodes, type of surgery for primary and nodes, differentiation of tumour, pathological nodal status, recurrence site, and duration after completion of treatment and follow-up. A total of 114 patients were included in the study. The mean duration of follow-up was 23.8 months. On follow-up, 30 patients had recurrence (26.32%) either locoregional or distant metastasis. Age less than 45 years, nodal positivity, presence of perineural invasion, extracapsular spread, and degree of differentiation were found to be statistically significant by univariate analysis (p < 0.05). On multivariate analysis, node positivity and presence of perineural invasion emerged as independent predictors of recurrence. Cox regression analysis showed trismus, node positivity, and perineural invasion are significantly associated with recurrence. Aggressive multimodality treatment achieves good local control rates even in locally advanced disease, and the intent of treatment should be curative. Node positivity, presence of perineural invasion, and presence of trismus are found as independent predictors of recurrence. Clinically, presence of trismus is associated with poorer outcomes in view of higher stage.

Advances in oral cancer detection

High incidence of oral carcinoma and its late-stage presentation are the major global healthcare issues. The World Health Organization (WHO) has set early diagnosis and prevention of oral cancer as their primary objective. It is important to consider the time of oral screening, as it plays a pivotal role in understanding the disease prognosis. Critical signs and symptoms that can be identified during initial oral screening can improve the chances of patient's survival. Reports suggest that socio-economic factors, lack of public awareness and delays from primary health care centers are few of the major parameters that contribute to patient's mortality and morbidity. Conventional technique of visual examination of the oral lesion can effectively monitor patient mortality when exposed to risk factors. However, several disadvantages limit the clinical utility of this technique. Thus, screening aids that efficiently differentiate between a benign and malignant lesion as well as deliver information about early OSCC can ameliorate the complications associated with oral cancer diagnosis. Recent advances in optical imaging systems, such as tissue-fluorescence imaging and optical coherence tomography have been proved to be considerably efficient. Additionally, extensive research has been directed towards nanoparticle-based immunosensors, DNA analysis, and salivary proteomics. However, lack of proper clinical trials and correlation with biopsy result hinder the usage of these screening techniques in clinics. In this review, we highlight the importance of early diagnosis of oral cancer as well as discuss about the effectiveness and limitations of the recent diagnostic aids. It can be stated that public awareness regarding routine oral examination and employing screening methods that are non-invasive, robust, and economic, would enhance early stage diagnosis of oral cancer and have a positive impact on patient's survival.

Impact of contrast ultrasound diagnosis for patients with liver cancer

BACKGROUND

Numerous studies have reported that contrast ultrasound (CU) can be utilized for diagnosis in patients with liver cancer (LC) accurately. However, no systematic review has addressed to assess its diagnostic impact on patients with LC. Thus, this systematic review will investigate the accurate of CU diagnosis on LC.

METHODS

A comprehensive literature search for relevant studies will be performed in the Cochrane Library, EMBASE, MEDILINE, Web of Science, PSYCINFO, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from inceptions to the March 10, 2019. All case-controlled studies investigating the impacts of CU diagnosis on LC will be included in this study. Two researchers will independently carry out study selection, quality assessment, and data extraction. The quality will be assessed by using Quality Assessment of Diagnostic Accuracy Studies tool. Statistical analysis will be conducted by RevMan V.5.3 (Cochrane Community, London, UK) and Stata V.12.0 software (Stata Corp, College Station).

RESULTS

This study will present the accuracy of CU diagnosis for patients with LC through the assessment of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of CU.

CONCLUSION

The findings of this study will summarize the current evidence for accuracy of CU diagnosis in patients with LC.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019127108.

Mesoporous Silica Nanomaterials: Versatile Nanocarriers for Cancer Theranostics and Drug and Gene Delivery

Mesoporous silica nanomaterials (MSNs) have made remarkable achievements and are being thought of by researchers as materials that can be used to effect great change in cancer therapies, gene delivery, and drug delivery because of their optically transparent properties, flexible size, functional surface, low toxicity profile, and very good drug loading competence. Mesoporous silica nanoparticles (MSNPs) show a very high loading capacity for therapeutic agents. It is well known that cancer is one of the most severe known medical conditions, characterized by cells that grow and spread rapidly. Thus, curtailing cancer is one of the greatest current challenges for scientists. Nanotechnology is an evolving field of study, encompassing medicine, engineering, and science, and it has evolved over the years with respect to cancer therapy. This review outlines the applications of mesoporous nanomaterials in the field of cancer theranostics, as well as drug and gene delivery. MSNs employed as therapeutic agents, as well as their importance and future prospects in the ensuing generation of cancer theranostics and drug and therapeutic gene delivery, are discussed herein. Thus, the use of mesoporous silica nanomaterials can be seen as using one stone to kill three birds.

Application of weighted gene co-expression network analysis to identify key modules and hub genes in oral squamous cell carcinoma tumorigenesis

Purpose

Oral squamous cell carcinoma (OSCC) is one of the most common malignant diseases worldwide, yet its molecular mechanisms are largely unknown. We aimed to construct gene co-expression networks to identify key modules and hub genes involved in the pathogenesis of OSCC.

Patients and methods

We used dataset GSE30784 to construct co-expression networks by weighted gene co-expression network analysis (WGCNA). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed by Database for Annotation, Visualization and Integrated Discovery (DAVID). Hub genes were screened and validated by other datasets.

Results

Turquoise and brown modules were found to be the most significantly related to tumorigenesis. Functional enrichment analysis showed that the turquoise module was associated with cell–cell adhesion, extracellular matrix and collagen catabolic process. A total of 10 hub genes (MMP1, TNFRSF12A, PLAU, FSCN1, PDPN, KRT78, EVPL, GGT6, SMIM5 and CYSRT1) were identified and validated at transcriptional and translational levels. Their genetic alteration and survival analysis were also revealed.

Conclusion

We identified two modules and 10 hub genes, which were associated with the tumorigenesis of OSCC. The two modules provided references that will advance the understanding of mechanisms of tumorigenesis in OSCC. Moreover, the hub genes may serve as biomarkers and therapeutic targets for precise diagnosis and treatment of OSCC in the future.

Retrospective study on recovery of 521 gastrointestinal tumor patients after laparoscopic surgery

Influencing factors for recovery of patients with gastrointestinal tumor after laparoscopic surgery were explored to promote recovery of patients. Clinical data from 521 gastrointestinal tumor patients who underwent laparoscopic surgery in Dalian Central Hospital were collected. The recovery of gastrointestinal function was recorded, and the factors that affected the recovery of gastrointestinal function were analyzed. All data were processed using Statistical Product and Service Solutions (SPSS) 21.0 software. t-test and F-test were used for univariate analysis, and multivariate linear regression was adopted for multivariate analysis. Results of univariate analysis displayed that age, starting time of postoperative activity, peritoneal drainage tube indwelling time, blood potassium level, sleep disorder, fasting and fluid deprivation time, duration of the first postoperative defecation/exhaustion, abdominal distention and pain reaction and social support level had significant influences on recovery of patients after operation (P<0.05). Results of multivariate analysis indicated that peritoneal drainage tube indwelling time, blood potassium level, fasting and fluid deprivation time and starting time of postoperative activity were independent factors affecting the recovery of patients after operation (P<0.05). Some methods are conducive to the recovery of gastrointestinal function in patients with gastrointestinal tumor, including the removal of peritoneal drainage tube, timely potassium supplementation, and diet recovery after laparoscopic surgery as soon as possible.

Identification and characterization of a highly metastatic epithelial cancer cell line from rat tongue cancer

OBJECTIVES

Tongue squamous cell carcinoma (TSCC) is a clinically devastating disease. However, most established TSCC cell lines currently show undesirable malignant behaviours. The purpose of this study is to establish a highly metastatic TSCC cell line to serve as a useful tool for basic research.

MATERIALS AND METHODS

TSCCs were induced by 4-nitroquinoline-1-oxide (4NQO) in Sprague-Dawley rats. Tumor cells were obtained from the cancer tissues by primary culture and were then purified by an in vitro invasion assay and a limiting dilution assay. The growth rate, cell cycle distribution, apoptotic rate, tumorigenicity and distant metastatic phenotypes of the rat tongue cancer cells were fully investigated and characterized.

RESULTS

To date, the rat tongue cancer cell line, named Rca-T, has been continuously cultured in vitro for over 210 passages and exhibit a long spindle-shaped morphology, adherent growth, and a stable epithelial phenotype. The population doubling time of Rca-T cells is 23.35 h. Approximately 39.8% of these cells are in S phase, and the apoptosis rate of Rca-T cells is 7.46%. Furthermore, in immunodeficient nude mice, both the xenograft rate and the incidence of experimental lung metastasis are 100%. The in vitro assays further reveal the highly malignant and epithelial-mesenchymal transition-like properties of Rca-T cells.

CONCLUSION

In this study, the tumorigenic and highly distant metastatic TSCC cell line Rca-T was established. The malignant features of this cell line, especially its metastatic potential, will enable a wealth of functional studies on the molecular mechanisms of TSCC metastasis in the future.

Epidemiological and Histopathological Aspects of Tongue Squamous Cell Carcinomas-Retrospective Study

Tongue squamous cell carcinoma is one of the most commonly diagnosed intraoral squamous cell carcinomas (25-40%), being considered an aggressive form of squamous cell carcinoma, as it is most commonly associated with lymph node metastases and the survival rate at five years is below 50%. In according with these data, we have proposed in this study to individualize an epidemiological and histopathological profile of the patients with such oral cancers, diagnosed and treated in the Oral and Maxillofacial Surgery Clinic and in the Otolaryngology Surgery Clinic of the Emergency Clinical County Hospital Craiova, between 2015-2017. The cases were histopathologically reassessed according to the latest WHO classification of head and neck tumors, the variables of interest being the age of the patients, the gender, the lesion topography, the histological subtype, the degree of tumor differentiation, the pTNM stage, the resection margin status and the Brandwein-Gensler prognostic score. Thus, we recorded an average age of 55.81±14.98 tongue cancer development, 65% of the casuistry being diagnosed during the 7th and 6th decades, with a slight prevalence in men, with development in two thirds of cases in the mobile portion of the tongue. Histopathologically, conventional forms of squamous cell carcinoma prevailed (53.7%), followed by varieties: acantholytic (26%), basaloid (13%), sarcomatoid (5.45%) and verrucous (1.85%). Moderate differentiated forms prevailed (44.44%), half of the cases falling within the moderate degree of Brandwein-Gensler's histological risk score and two thirds were diagnosed in pTNM stage II and III of the disease, and a quarter of the cases having the margins invaded.

Tissue and serum expression of TGM-3 may be prognostic marker in patients of oral squamous cell carcinoma undergoing chemo-radiotherapy

Radioresistance is one of the main determinants of treatment outcome in oral squamous cell carcinoma (OSCC), but its prediction is difficult. Several authors aimed to establish radioresistant OSCC cell lines to identify genes with altered expression in response to radioresistance. The development of OSCC is a multistep carcinogenic process that includes activation of several oncogenes and inactivation of tumour suppressor genes. TGM-3 is a tumour suppressor gene and contributes to carcinogenesis process. The aim of this study was to estimate serum and tissue expression of TGM-3 and its correlation with clinico-pathological factors and overall survival in patients of OSCC undergoing chemo-radiotherapy. Tissue expression was observed in formalin fixed tissue biopsies of 96 cases of OSCC and 32 healthy controls were subjected to immunohistochemistry (IHC) by using antibody against TGM-3 and serum level was estimated by ELISA method. mRNA expression was determined by using Real-Time PCR. Patients were followed for 2 year for chemo radiotherapy response. In OSCC, 76.70% cases and in controls 90.62% were positive for TGM-3 IHC expression. TGM-3 expression was cytoplasmic and nuclear staining expressed in keratinized layer, stratum granulosum and stratum spinosum in controls and tumour cells. Mean serum TGM-3 in pre chemo-radiotherapy OSCC cases were 1304.83±573.55, post chemo-radiotherapy samples were 1530.64±669.33 and controls were 1869.16±1377.36, but difference was significant in pre chemo-radiotherapy samples as compared to controls (p<0.018). This finding was also confirmed by real- time PCR analysis in which down regulation (-7.92 fold change) of TGM-3 in OSCC as compared to controls. TGM-3 expression was significantly associated with response to chemo-radiotherapy treatment (p<0.007) and overall survival (p<0.015). Patents having higher level of TGM-3 expression have good response to chemo-radiotherapy and also have better overall survival. TGM-3 may serve as a candidate biomarker for responsiveness to chemo-radiotherapy treatment in OSCC patients.

Identification of Differentially Expressed Genes Induced by Aberrant Methylation in Oral Squamous Cell Carcinomas Using Integrated Bioinformatic Analysis

Oral squamous cell carcinoma (OSCC) is a malignant disease. Methylation plays a key role in the etiology and pathogenesis of OSCC. The goal of this study was to identify aberrantly methylated differentially expressed genes (DEGs) in OSCCs, and to explore the underlying mechanisms of tumorigenesis by using integrated bioinformatic analysis. Gene expression profiles (GSE30784 and GSE38532) were analyzed using the R software to obtain aberrantly methylated DEGs. Functional enrichment analysis of screened genes was performed using the DAVID software. Protein–protein interaction (PPI) networks were constructed using the STRING database. The cBioPortal software was used to exhibit the alterations of genes. Lastly, we validated the results with the Cancer Genome Atlas (TCGA) data. Twenty-eight upregulated hypomethylated genes and 24 downregulated hypermethylated genes were identified. These genes were enriched in the biological process of regulation in immune response, and were mainly involved in the PI3K-AKT and EMT pathways. Additionally, three upregulated hypomethylated oncogenes and four downregulated hypermethylated tumor suppressor genes (TSGs) were identified. In conclusion, our study indicated possible aberrantly methylated DEGs and pathways in OSCCs, which could improve the understanding of the underlying molecular mechanisms. Aberrantly methylated oncogenes and TSGs may also serve as biomarkers and therapeutic targets for the precise diagnosis and treatment of OSCCs in the future.

PAI-1, CAIX, and VEGFA expressions as prognosis markers in oral squamous cell carcinoma

BACKGROUND

In oral squamous cell carcinoma (OSCC), the HIF-1 complex promotes the expression of genes involved in specific mechanisms of cell survival under hypoxic conditions, such as plasminogen activator inhibitor-1 (PAI-1), carbonic anhydrase 9 (CAIX), and vascular endothelial growth factor A (VEGFA). The study aimed to investigate the presence and prognostic value of PAI-1, CAIX, and VEGFA in OSCC.

MATERIALS AND METHODS

Immunohistochemistry was used to analyze the expressions of these proteins in 52 tumoral tissue samples of patients with OSCC, surgically treated and followed by a minimum of 24 months after surgery. The correlations between protein expressions and clinicopathological parameters and prognosis were analyzed.

RESULTS

Positive PAI-1 membrane expression was significantly associated with local disease relapse (P = .027). Multivariate analysis revealed that the positive PAI-1 membrane expression is an independent marker for local disease relapse, with approximately 14-fold increased risk when compared to negative expression (OR = 14.49; CI = 1.40-150.01, P = .025). Strong PAI-1 cytoplasmic expression was significantly associated with the less differentiation grade (P = .027). Strong CAIX membrane expression was significantly associated with local disease-free survival (P = .038). Positive CAIX cytoplasmic expression was significantly associated with lymph node affected (P = .025) and with disease-specific survival (P = .022). Multivariate analysis revealed that the positive CAIX cytoplasmic expression is an independent risk factor for disease-related death, increasing their risk approximately 3-fold when compared to negative expression (HR = 2.84; CI = 1.02-7.87, P = .045). Positive VEGFA cytoplasmic expression was significantly associated with less differentiation grade (P = .035).

CONCLUSION

Our results suggest a potential role for these expressions profiles as tumor prognostic markers in OSCC patients.

NLRP3 promotes tumor growth and metastasis in human oral squamous cell carcinoma

Background

Inflammasomes are reported to be abnormally expressed and activated in several malignancies and play important roles in tumor development. The present study was designed to investigate the expression and function of the NLR family pyrin domain containing protein 3 (NLRP3) inflammasome in oral squamous cell carcinoma (OSCC).

Methods

NLRP3 expression in OSCC cell lines and the normal human immortalized oral epithelial cells (HIOEC) was determined by real-time PCR and western blot. Immunohistochemistry was used to examine the expression of NLRP3 and IL-1β in the paraffin-embedded OSCC tissues. The proliferation of OSCC cells was detected by the 3-(4,5-dimethylthiazol- 2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay and cell colony formation ability of the OSCC cells was also evaluated. Tumor cell migration or invasion was measured by the transwell assay and related protein markers were determined by western blot. A mouse xenograft model was established to investigate the OSCC tumor growth in vivo.

Results

Significant higher expression of NLRP3 was observed in the OSCC cells. Obvious expression of NLRP3 and IL-1β was found in the paraffin-embedded OSCC tissues, and the NLRP3 expression levels were correlated with the tumor size, lymphonode metastatic status and IL-1β expression. Downregulating NLRP3 expression markedly reduced the cleavage of caspase-1 and production of IL-1β in OSCC cells. NLRP3 knockdown also inhibited the proliferation, migration and invasion of OSCC cells. Further investigation indicated that expressions of E-cadherin and vimentin in OSCC cells were increased, while N-cadherin expression was decreased after NLRP3 knockdown. Downregulating NLRP3 expression in OSCC cells significantly reduced the tumor growth in vivo.

Conclusions

Our data suggested that the increased expression of NLRP3 in OSCC was associated with tumor growth and metastasis. NLRP3 may be considered as a potential target for OSCC therapy.

Electronic supplementary material

The online version of this article (10.1186/s12885-018-4403-9) contains supplementary material, which is available to authorized users.

Imaging performance and clinical value of contrast-enhanced ultrasonography and computed tomography in the diagnosis of liver cancer

The imaging performance and clinical value of contrast-enhanced ultrasonography (CEUS) combined with CT in diagnosis of liver cancer were investigated. A total of 426 liver cancer patients treated in Yuhuangding Hospital (Yantai, China) from February 2011 to May 2016 were selected. Among them, 222 patients underwent CEUS examination, 204 patients underwent CT examination, and 102 patients underwent CEUS combined with CT examination. Sensitivity and specificity of the three methods were examined. CT showed a low density in 92.6% of patients (189 patients) and a high-low hybrid density in 6.4% (13 patients), with calcification seen in 2.5% of patients (5 patients) and bleeding in 3.4% (7 patients). Lesions: 76.5% (156 cases) of patients with multiple type, 23.5% (48 cases) with single type. CEUS showed overall enhancement in 53.2% patients (118 cases), heterogenous enhancement in 16.7% (37 cases), peripheral enhancement in 18.9% of patients (42 cases), necrosis of liquefaction in 11.3% (25 cases). In 65.3% (145 cases) of patients, the portal venous phase and the delayed phase showed a low enhancement, while 34.7% (77 cases) showed no enhancement. The sensitivity and specificity rates of CEUS combined with CT detection of liver cancer were 87.8, 88.2 and 94.1%, respectively. The ROC curve analysis showed that the sensitivity and specificity of CEUS in the diagnosis of liver cancer were 76.8 and 78.9%, respectively. The sensitivity and specificity of CT were 81.2 and 85.5%, respectively. The sensitivity and specificity of CEUS combined with CT were 90.4 and 92.7%, respectively. CEUS combined with CT detection can make-up for the deficiencies of each other and effectively improve the coincidence rate of liver cancer diagnosis, which can be used as an effective examination method for the diagnosis of liver cancer.

John MA. Detection of surgical margins in oral cavity cancer: the role of dynamic optical contrast imaging

PURPOSE OF REVIEW

The quantity of tissue removed during an oncologic surgical procedure is not standardized and there are numerous reports of local recurrence despite histologically adequate resection margins. The oral cavity is one of the sites in the head and neck with high chances of recurrence following negative margins. To address this need, this article reviews the recent applications of Dynamic Optical Contrast Imaging (DOCI) towards both oral screening and the intraoperative evaluation of tumor margins in head and neck surgery.

RECENT FINDINGS

Human ex-vivo and in-vivo trials suggest DOCI is well tolerated, low-cost, and sensitive for differentiating cancerous from normal tissues throughout the head and neck, in addition to the oral cavity. Ex-vivo imaging of OSCC specimens generated histologically verified image contrast. Furthermore, in-vivo intraoperative results demonstrate significant potential for image-guided detection and resection of oral cavity squamous cell carcinoma (OSCC).

SUMMARY

DOCI augments tissue contrast and may enable surgeons to clinically screen patients for oral cancer, make histologic evaluations in vivo with fewer unnecessary biopsies, delineate clinical margins for tumor resection, provide guidance in the choice of biopsy sites, and preserve healthy tissue to increase the postoperative functionality and quality of life of the patient.

Streptococcus salivarius-mediated CD8+ T cell stimulation required antigen presentation by macrophages in oral squamous cell carcinoma

It has been shown that the peripheral blood mononuclear cells (PBMCs) from oral squamous cell carcinoma (OSCC) patients presented cytotoxic CD8 T cell response against Streptococcus salivarius (S. salivarius), of which the frequency was positively associated with recurrence-free survival in OSCC patients. To identify the conditions required for regulating S. salivarius-specific CD8 T cell-mediated cytotoxicity, we selectively depleted individual components of the PBMCs, and observed that the depletion of monocytes/macrophages, but not other immune cell subsets, significantly downregulated the S. salivarius-specific CD8 T cell cytotoxicity. Monocyte/macrophage alone was sufficient to reconstitute optimal granzyme B expression from S. salivarius-specific CD8 T cells. Also, both the memory and the naive CD8 T cells reacted to S. salivarius-stimulation, with the memory CD8 T cells presenting significantly higher S. salivarius-reactivity. Using M1- and M2-polarized macrophages from circulating monocytes, we found that M1-polarized macrophages, with significantly higher IL-12 expression and significantly lower IL-10 and MHC class II molecule expression, was more effective at promoting granzyme B responses in CD8 T cells, and required CD80/CD86 costimulating molecules for optimal responses. Interestingly, the tumor-associated macrophages (TAMs) from resected tumors presented characteristics of M2-polarized macrophages with high MHC class II expression and low IL-12 secretion. The frequency of tumor-infiltrating S. salivarius-specific cytotoxic CD8 T cell was inversely correlated with the level of IL-10 secretion and the MHC class II molecule expression in autologous TAMs. Together, we demonstrated that monocyte/macrophages presented essential antigen-presentation and costimulatory roles in CD8 T cell-mediated S. salivarius-specific granzyme B responses, and the polarization of macrophages could influence the potency of CD8 T cell responses.

Early Detection of Oral Cancer- Dentists’ Knowledge and Practices in the United Arab Emirates

Objectives: The aim of this study was to evaluate the knowledge, opinions and practices of dentists regarding early detection of oral cancer in the United Arab Emirates (UAE). Method: A cross-sectional study was conducted using a simple random sampling technique with a self-reported questionnaire applied to 298 dentists, working in private and public sectors in three cities (Abu Dhabi, Dubai and Sharjah) in the UAE. Dentists’ knowledge about risk factors and diagnostic concepts of oral cancer, current practices and opinions as well as interest in continuing education programs were assessed. Results: The dentists, aged 23-65 years, were generally aware of the major risk factors most likely associated with oral cancer. Thirty percent of the participants identified the tongue as the most common site on which oral cancer develops. The best known clinical presentation of oral cancer identified by the respondents was a persistent ulcer (87.6 %). Only thirty dentists (9.9%) were comfortable in performing a biopsy in their clinic. Less than half (48.0%) had attended a continuing education course on oral cancer within the past 5 years. The majority of the participants (84.9%) felt that they needed further training on oral cancer detection. Conclusion: The findings of the present study identified several deficiencies in the knowledge of dentists working in the UAE with regard to early detection of oral cancer. Some changes to dental educational and training could be made to improve the confidence and ability of dentists in this regard.

The importance of ctokeratins in the early detection of oral squamous cell carcinoma

Background

Oral cancer is usually diagnosed at advanced stages. The pattern of keratin expression in normal epithelia and the change in their expression in premalignant lesions and carcinomas have suggested the possibilities of improving diagnosis. The aim of this study is to determine the use of acidic cytokeratins (CKs) as biomarkers of histopathological progression in oral carcinogenesis.

Materials and Methods

A total of 50 paraffin blocks of histological specimens diagnosed as hyperplastic epithelium, dysplastic epithelium, well-differentiated squamous cell carcinoma (SCC) and poorly-differentiated SCC (10 specimens each) were included in this study, in addition to 10 normal oral mucosal samples. All samples were stained immunohistochemically with CKs (10-ab1, 14, 16-ab1, 18-dc10 and 19-abs10) using Ventana Medical Systems (Arizona-USA). The expression of CKs antigen was evaluated as absent, mild, moderate and severe.

Results

CK10-ab1 was found to be positive in the suprabasal layers of all specimens in normal and hyperplastic epithelium, while it was moderate in dysplastic epithelium and mild in well-differentiated SCC. CK10-ab1 was negative in all samples with poorly-differentiated SCC (P < 0.005). CK14 was positive in all specimens of all groups whereas CK16-ab1 was negative in all specimens of all groups. The stain of CKs 18-dc10 and 19-abs10 was restricted to the basal cells only in normal, hyperplastic and dysplastic epithelium, while it was mild in well-differentiated and poorly-differentiated SCC (P < 0.01).

Conclusion

CK10-ab1 disappeared gradually with the progression of malignant changes of squamous cells whereas CKs 18-dc10 and 19-abs10 increased gradually at the same time. Such changes in the protein mapping of squamous cells need more investigation for a better understanding of oral SCC.

Head and Neck Cancers Case Control Study of HIV Positive Compared to Negative Patients in a Ugandan Population Sample

Increased availability of highly active anti-retroviral therapy (HAART) has led to a change in the spectrum of neoplastic diseases affecting people living with HIV. Some cancers such as invasive cervical carcinoma and anal cancers have not changed or instead risen while others such as Kaporsi's sarcoma have seen a sharp decline. The aim of this study was to compare clinical findings at presentation between HIV positive and Negative patients with head and neck cancers using a retrospective case control design. The study was done at the Uganda cancer Institute by performing a manual match of records in the head and neck cancer database at a ratio of 1:2 cases: controls. The matching was done on the age group, gender and diagnosis. Clinical and demographic characteristics between HIV positive and HIV negative head and neck cancer patients were compared using chi square and a multinomial model including ECOG performance score, stage, grade and duration group was run. In the multinomial regression only duration group was significant with the HIV positive patients being more likely to present after a longer duration of the symptoms than HIV negative patients (OR=0.42 CI 0.20-0.86 p=0.02). The data does not show statistically significant difference between HIV positive and HIV negative head and neck cancer patients in terms of presentation at time of diagnosis except for duration of symptoms group. This study clearly demonstrates the need for more research on head and neck cancer in Africa in the context of HIV/AIDS, since the reasons for the high HIV prevalence among this cohort of patients hasn't been established.

Screening Projects for Oral Carcinoma in Relation to Health Education and Patients' Compliance: Study on 600 Participants

Aims and Objectives:

The lack of information among the population regarding the existence of oral squamous cell carcinoma (OSCC) and the lack of attention and expertise in examining the oral cavity of dentists and clinicians still remain very worrying and could explain the high incidence of OSCC. The aim of this study is to evaluate the level of awareness of OSCC among 600 participants from Southern Italy.

Materials and Methods:

A 13-question survey was prepared and distributed to 600 participants divided into two subgroups, the first one of 300 patients referring to the Department of Neuroscience, Reproductive, and Odontostomatological Sciences, University Federico II of Naples, for the treatment of dental pathologies, and the second one of 300 patients referring to the Department of Internal Medicine of the Second University of Naples for the diagnosis and treatment of cardiovascular diseases. Statistical analysis consisted in the calculation of percentages related to the answers given by patients. Comparison of percentages was after performed between the two subgroups.

Result:

Only 175 participants (29.1%) knew about the existence of pathologies which can affect the oral mucosa, and only 46 (7.6%) were aware that carcinoma can arise in the oral cavity; 345 (57,5%) stated that they had periodical dental visits, at least once a year but none of them stated they had a visit for the identification of oral carcinomas.

Conclusion:

The data acquired must be taken into consideration to outline essential socio-healthcare educational projects on carcinoma and its risk factors, training programs to increase dentists and clinicians’ competences, and to evaluate the feasibility and effectiveness of oral carcinoma screening programs.

Cytotoxic T cell responses to Streptococcus are associated with improved prognosis of oral squamous cell carcinoma

Several species of Streptococcus, such as S. salivarius, S. mitis, and S. anginosus, are found to extensively colonize the oral cavity and the upper respiratory tract, and have been shown to increase in patients with oral squamous cell carcinoma (OSCC). Accumulating evidence have revealed that commensal bacteria are involved in antitumor immunity via T cell-mediated mechanisms, but the role of Streptococcus enrichment in OSCC is yet unclear. In this study, we stimulated peripheral blood mononuclear cells from non-cancer controls (NCs) and OSCC patients with S. salivarius, S. mitis, and S. anginosus. We observed that compared to NC subjects, OSCC patients at earlier stages had higher frequencies of granzyme B-expressing CD8 T cells for all Streptococcus species tested, while OSCC patients at more advanced stages had higher frequencies of granzyme B-expressing CD8 T cells for S. anginosus but not other Streptococcus species. In OSCC patients, the Streptococcus-reactive CD8 T cells presented significantly lower levels of PD-1 and TIM-3 expression than Streptococcus-nonreactive CD8 T cells. The clinical outcomes of OSCC patients in our cohort were tracked for 24 months after the resection of the primary tumor. In patients that did not present tumor recurrence, the frequencies of S. salivarius-reactive and S. mitis-reactive CD8 T cells were significantly higher than that in patients that developed recurrent tumor. Furthermore, in patients with tumor recurrence, the duration between primary tumor resection and tumor recurrence was positively associated with the frequencies of S. salivarius-reactive and S. anginosus-reactive CD8 T cells. Together, we demonstrated that Streptococcus-reactive CD8 T cell responses might contribute to antitumor immunity in OSCC patients.

Evaluation of the diagnostic efficacy and spectrum of autofluorescence of benign, dysplastic and malignant lesions of the oral cavity using VELscope

OBJECTIVES

Conventional oral examination and biopsy are the only reliable methods for the early detection of oral cancer at present. Autofluorescence examination of oral tissues using the VELscope has been suggested as an adjunctive tool for cancer detection and diagnosis. The aim of our study was to evaluate the efficacy of the VELscope in recognizing dysplastic and/or neoplastic changes in oral mucosal lesions that were identified on conventional oral examination.

MATERIALS AND METHODS

Two hundred patients with oral mucosal lesions were subjected to conventional oral examination followed by VELscope examination and their autofluorescence characteristics were compared with the histopathological diagnosis. The sensitivity, specificity, positive and negative predictive values of the VELscope examination was calculated.

RESULTS

The VELscope examination showed sensitivity and specificity values of 76% (95% CI: 54.87-90.64%) and 66.29% (95% CI: 58.76-73.24%) respectively while the positive and negative predictive values were 24.36% (95% CI: 19.22-30.36%) and 95.08% (95% CI: 90.52-97.51%) respectively.

CONCLUSION

The VELscope examination alone cannot provide a definitive diagnosis as to the presence of dysplastic tissue change. In spite of having a reasonable sensitivity, the high number of false-positive results limits its efficiency as an adjunct. However, a high negative predictive value can serve to alleviate patient anxiety regarding suspicious mucosal lesions in a general practice setting.