Statistical profiling of oral cancer and the prediction of outcome

Targeting autophagy to enhance chemotherapy and immunotherapy in oral cancer

Oral cancer is a highly malignant disease characterized by recurrence, metastasis, and poor prognosis. Autophagy, a catabolic process induced under stress conditions, has been shown to play a dual role in oral cancer development and therapy. Recent studies have identified that autophagy activation in oral epithelial cells suppresses cancer cell survival by inhibiting key pathways such as the mammalian target of rapamycin (mTOR) and mitogen-activated protein kinase (MAPK), while activating the adenosine monophosphate-activated protein kinase (AMPK) pathway. Inducing autophagy promotes degradation of eukaryotic initiation factor 4E, thus reducing metastasis and enhancing the efficacy of chemotherapy, radiotherapy, and immunotherapy. Furthermore, autophagy induction can modulate the tumor immune microenvironment and enhance antitumor immunity. This review comprehensively summarizes the relationship between autophagy and oral cancer, focusing on its mechanisms and therapeutic potential when combined with conventional treatments. While promising, the precise mechanisms and clinical applications of autophagy inducers in oral cancer therapy remain to be elucidated, offering new directions for future research to improve treatment outcomes and reduce recurrence.

Prognostic risk factors of buccal squamous cell carcinoma: A case-control study

OBJECTIVES

To describe the clinicopathologic presentation of buccal squamous cell carcinoma and identify risks factors for recurrence and overall survival.

METHODS

This is a retrospective case-control study of patients with oral cavity squamous cell carcinoma (OCSCC) treated at a single tertiary care center between 2010 and 2022. All patients with buccal subsite OCSCC treated during this time frame were included and paired with a randomly selected age and gender matched patient with non-buccal OCSCC. Relevant data was collected via chart review.

RESULTS

Seventy-seven patients with buccal SCC were matched with 77 non-buccal OCSCC controls. The median follow-up time was 27 months (IQR 14-61). Median age was 67 years (IQR 57-75) and 53% of the cohort was female. Twenty (26%) buccal SCC patients experienced a recurrence versus 19 (25%) in the controls. Age ≥65-years-old increased odds of all-cause mortality in the buccal SCC group, but not in the control group. Perineural invasion and positive margins increased odds of recurrence in the buccal group only. Overall survival and progression-free survival did not differ between the groups, despite a greater number of T2 buccal tumors and T1 non-buccal tumors.

CONCLUSIONS

Buccal SCC presents at a higher T stage than other oral cavity SCC subsite and may exhibit variance in the pathologic risk factors that predict poor outcomes versus non-buccal OCSCC. Despite these relatively minor differences, however, oncologic outcomes between these groups were similar.

Immunomodulatory effects of Triphala and its constituents in oral squamous cell carcinoma and oral precancer

Oral squamous cell carcinoma shows increased occurrence in those who consume tobacco products, alcohol, betel quid, and areca nut, and is also considered to occur due to genetic alteration. Though there are numerous advancements in treatment, survival remains a question with late diagnosis. Hence, there are continuous inventions of new drugs. The introduction of Ayurveda in the therapy has paved the way for the longevity of the patients affected. One such introduction is the use of Triphala. The current study aims to review the anti-oxidant, anti-proliferative, anti-microbial, and apoptotic action of Triphala and thus evaluate the anti-cancer action of Triphala. A literature search was done, in various electronic databases and the data were extracted according to the predefined criteria. Original studies of 19 reports were included in the analysis. Nineteen (six studies with Triphala combination) In vitro/In vivo studies were included in this systematic review. The included study showed that Triphala effectively modulates the immune system. The effects included were anti-oxidative, immune modulation, anti-proliferative, tumor suppression, apoptotic effect, reversal of precancerous lesion, and anti-microbial action. The analyses also showed that there is no side effect of Triphala up to the recommended dosage. Triphala, is a nourishing supplement that is well-known in Ayurveda for its capacity to restore healthy tissues and promote aging gracefully through its properties such as anti-oxidant, ant-proliferative, anti-inflammatory, cytotoxic apoptotic, and immune-modulatory properties. Hence, Triphala can be a promising drug in the prevention and treatment of oral cancer.

Prognostic model revealing pyroptosis-related signatures in oral squamous cell carcinoma based on bioinformatics analysis

One of the most common oral carcinomas is oral squamous cell carcinoma (OSCC), bringing a heavy burden to global health. Although progresses have been made in the intervention of OSCC, 5 years survival of patients suffering from OSCC is poor like before regarding to the high invasiveness of OSCC, which causes metastasis and recurrence of the tumor. The relationship between pyroptosis and OSCC remains to be further investigated as pyroptosis in carcinomas has gained much attention. Herein, the key pyroptosis-related genes were identified according to The Cancer Genome Atlas (TCGA) dataset. Additionally, a prognostic model was constructed based upon three key genes (CTLA4, CD5, and IL12RB2) through least absolute shrinkage and selection operator (LASSO) analyses, as well as univariate and multivariate COX regression in OSCC. It was discovered that the high expression of these three genes was associated with the low-risk group. We also identified LAIR2 as a hub gene, whose expression negatively correlated with the risk score and the different immune cell infiltration. Finally, we proved that these three genes were independent prognostic factors linked to overall survival (OS), and reliable consequences could be predicted by this model. Our study revealed the relationship between pyroptosis and OSCC, providing insights into new treatment targets for preventing and treating OSCC.

Synergistic Phototherapy-Molecular Targeted Therapy Combined with Tumor Exosome Nanoparticles for Oral Squamous Cell Carcinoma Treatment

Oral squamous cell carcinoma (OSCC) contributes to more than 90% of all oral malignancies, yet the performance of traditional treatments is impeded by limited therapeutic effects and substantial side effects. In this work, we report a combinational treatment strategy based on tumor exosome-based nanoparticles co-formulating a photosensitizer (Indocyanine green) and a tyrosine kinase inhibitor (Gefitinib) (IG@EXOs) for boosting antitumor efficiency against OSCC through synergistic phototherapy-molecular targeted therapy. The IG@EXOs generate distinct photothermal/photodynamic effects through enhanced photothermal conversion efficiency and ROS generation, respectively. In vivo, the IG@EXOs efficiently accumulate in the tumor and penetrate deeply to the center of the tumor due to passive and homologous targeting. The phototherapy effects of IG@EXOs not only directly induce potent cancer cell damage but also promote the release and cytoplasmic translocation of Gefitinib for achieving significant inhibition of cell proliferation and tumor angiogenesis, eventually resulting in efficient tumor ablation and lymphatic metastasis inhibition through the synergistic phototherapy-molecular targeted therapy. We envision that the encouraging performances of IG@EXOs against cancer pave a new avenue for their future application in clinical OSCC treatment.

Comparison of histopathological margins after resection of oral squamous cell carcinoma using sharp dissection versus mono-polar electrocautery in T1 and T2 tumors

The study aims to compare histopathological margins after resection of oral squamous cell carcinoma (OSCC) with different surgical techniques: conventional sharp resection (SR) with scalpel versus monopolar electrocautery (ME). Hence, the question arises whether thermal damage by performing monopolar electrocautery surgery will lead to close margins more frequently than by using scalpels. 152 patients were included in this study. All patients received a primary tumor resection either performed with SR or with ME. Surgical margins were distributed into two groups: ≥5 mm (clear margins) and < 5 mm (close or involved margins). For comparing homogeneous groups, we considered tumor localizations, diameter and depth of invasion. The results were statistically analyzed by applying the Wilcoxon-Mann-Whitney-U-Test. The distribution of tumor diameter and depth of invasion was equal in both groups. There was no statistically significant difference between the amount of free surgical margins using SR or ME (p = 0.884). According to this study, the use of the monopolar electrocautery for tumor resection in the oral cavity does not increase the rate of compromised resection margins compared to the conventional scalpel.

A novel pyroptosis-related signature predicts prognosis and indicates immunotherapy in oral squamous cell carcinoma

BACKGROUND

Oral squamous cell carcinoma (OSCC) has been recognized as a frequently occurring oral malignant tumor. Pyroptosis plays an extremely important role in the occurrence and development of cancer, but the role of pyroptosis in OSCC remains unclear.

METHODS

OSCC-related data were obtained from the TCGA and GEO databases. A PSscore risk model was constructed through LASSO regression analysis. The GEO database was utilized as the validation set of the model. The "ESTIMATE" and "CIBERSORT" algorithms were utilized to additionally evaluate the relationship between the immune cell score and PSscore. TIDE and IPS algorithms were used to assess patient response to immunotherapy. In addition, Western blot analysis and MTT assay was used to further validate key genes.

RESULTS

Comprehensive bioinformatics analysis showed that a low-PSscore had a significant survival advantage, richer immune cell infiltration, more active immune-related pathways, higher TME scores, and lower tumor purity. The results of TIDE and IPS analysis indicated that the high-PSscore group had higher immune escape potential and was less sensitive to immunotherapy. In contrast, the low-PSscore group patients might be more sensitive to PD1 and CTLA4 + PD1 immunotherapy. Univariate and multivariate COX results indicated that PSscore was an independent prognostic factor in OSCC patients. Another important finding is that BAK1 is a potential target of OSCC and is related to the Nod-like receptor signaling pathway. Knockdown of BAK1 can significantly reduce the proliferation of OSCC cells.

CONCLUSION

The PSscore model could be utilized as a powerful prognostic indicator and can help in the development of new immunotherapies.

Predicting oral cancer survival-Development and validation of an Asia-Pacific nomogram

BACKGROUND

Nomograms are graphical calculating devices that predict response to treatment during cancer management. Oral squamous cell carcinoma (OSCC) is a lethal and deforming disease of rising incidence and global significance. The aim of this study was to develop a nomogram to predict individualized OSCC survival using a population-based dataset obtained from Queensland, Australia and externally validated using a cohort of OSCC patients treated in Hong Kong.

METHODS

Clinico-pathological data for newly diagnosed OSCC patients, including age, sex, tumour site and grading, were accessed retrospectively from the Queensland Cancer Registry (QCR) in Australia and the Clinical Data Analysis and Reporting System (CDARS) in Hong Kong. Multivariate Cox proportional hazard regression was used to construct overall survival (OS) and cancer-specific survival (CSS) prediction models. Nomograms were internally validated using 10-fold cross validation, and externally validated against the Hong Kong dataset.

RESULTS

Data from 9885 OSCC patients in Queensland and 465 patients from Hong Kong were analysed. All clinico-pathological variables significantly influenced survival outcomes. Nomogram calibration curves demonstrated excellent agreement between predicted and actual probability for Queensland patients. External validation in the Hong Kong population demonstrated slightly poorer nomogram performance, but predictive power remained strong.

CONCLUSION

Based upon readily available data documenting patient demographic and clinico-pathological variables, predictive nomograms offer pragmatic aid to clinicians in individualized treatment planning and prognosis assessment in contemporary OSCC management.

Assessment of quality of life after soft tissue resection of head and neck carcinoma and reconstruction with double-paddle peroneal artery perforator free flap

We aimed to assess the quality of life for head and neck carcinoma (HNC) patients who underwent soft tissue resection and reconstruction with double-paddle peroneal artery perforator (DPAP) free flap. The quality of life was assessed by means of the University of Washington quality of life (UW-QOL) and the 14-item Oral Health Impact Profile (OHIP-14) questionnaires at 12 months postoperatively. Data from 57 patients were retrospectively analysed. Out of these, 51 patients were at TNM stage III or IV. Finally, 48 patients finished and returned the two questionnaires. In the UW-QOL questionnaire, the mean (SD) higher scores were pain 76.5 (6.4), shoulder 74.3 (9.6), and activity 71.6 (6.1), whereas the lower scores were chewing 49.7 (5.2), taste 51.1 (7.7), and saliva (56.7 (7.4). In the OHIP-14 questionnaire, the higher-scoring domains were psychological discomfort (69.3 (9.6) and psychological disability 65.2 (5.8), whereas the lower-scoring domains were handicap 28.7 (4.3) and physical pain 30.4 (8.1). The DPAP free flap significantly improved appearance, activity, shoulder, mood, psychological discomfort, and handicap compared with pedicled pectoralis major myocutaneous flap reconstruction. In conclusion, DPAP free flap for reconstruction of tissue defects after soft tissue resection of HNC significantly improved the patients' QOL compared to pedicled pectoralis major myocutaneous flap reconstruction.

Therapeutic Potential of Dimethyl Fumarate in Counteract Oral Squamous Cell Carcinoma Progression by Modulating Apoptosis, Oxidative Stress and Epithelial-Mesenchymal Transition

Oral squamous cell carcinoma (OSCC) is a common human tumor, that originates from buccal mucosa and the tongue, associated with a high mortality rate. Currently, the treatment for OSCC involves surgery, chemotherapy and radiotherapy; however, survival outcomes for OSCC patients remain poor. For this reason, it is necessary to investigate new therapeutic strategies to counteract the progression of OSCC. In this study, we aimed to evaluate the role of dimethyl fumarate (DMF) in modulation of OSCC progression, both in vitro and in an in vivo orthotopic xenograft model. In vitro results revealed that DMF was able to reduce the expression of anti-apoptotic factors as BCL-2 and increased the expression of pro-apoptotic factors as Bax, Caspase-3 and BID. DMF appears to be involved in the modulation of oxidative stress mediators, such as MnSOD and HO-1. Furthermore, DMF showed to reduce the migratory ability of tumor cells and to modulate the expression of markers of epithelial-mesenchymal transition (EMT), as N-cadherin and E-cadherin. The in vivo study confirmed the data obtained in vitro significantly decreasing tumor mass and also reducing oxidative stress and apoptosis. Therefore, based on these results, the use of DMF could be considered a promising strategy to counteract oral cancer progression.

F. nucleatum facilitates oral squamous cell carcinoma progression via GLUT1-driven lactate production

BACKGROUND

Tumor-resident microbiota has been documented for various cancer types. Oral squamous cell carcinoma (OSCC) is also enriched with microbiota, while the significance of microbiota in shaping the OSCC microenvironment remains elusive.

METHODS

We used bioinformatics and clinical sample analysis to explore relationship between F. nucleatum and OSCC progression. Xenograft tumor model, metabolic screening and RNA sequencing were performed to elucidate mechanisms of pro-tumor role of F. nucleatum.

FINDINGS

We show that a major protumorigenic bacterium, F. nucleatum, accumulates in invasive margins of OSCC tissues and drives tumor-associated macrophages (TAMs) formation. The mechanistic dissection shows that OSCC-resident F. nucleatum triggers the GalNAc-Autophagy-TBC1D5 signaling, leading to GLUT1 aggregation in the plasma membrane and the deposition of extracellular lactate. Simultaneous functional inhibition of GalNAc and GLUT1 efficiently reduces TAMs formation and restrains OSCC progression.

INTERPRETATION

These findings suggest that tumor-resident microbiota affects the immunomodulatory and protumorigenic microenvironment via modulating glycolysis and extracellular lactate deposition. The targeted intervention of this process could provide a distinct clinical strategy for patients with advanced OSCC.

FUNDING

This work was supported by the National Natural Science Foundation of China for Key Program Projects (82030070, to LC) and Distinguished Young Scholars (31725011, to LC), as well as Innovation Team Project of Hubei Province (2020CFA014, to LC).

Oral squamous cell carcinoma diagnosis in digitized histological images using convolutional neural network

Background/purpose

Diagnostic methods of oral squamous cell carcinoma (SCC) using artificial intelligence (AI) and digital-histopathologic images have been developed. However, previous AI training methods have focused on the cellular atypia given by the training of high-magnification images, and little attention has been paid to structural atypia provided by low-power wide fields. Since oral SCC has histopathologic types with bland cytology, both cellular atypia and structural atypia must be considered as histopathologic features. This study aimed to investigate AI ability to judge oral SCC in a novel training method considering cellular and structural atypia and their suitability.

Materials and methods

We examined digitized histological whole-slide images from 90 randomly selected patients with tongue SCC who attended a dental hospital. Image patches of 1000 × 1000 pixels were cut from whole-slide images at 0.3125-, 1.25-, 5-, and 20-fold magnification, and 90,059 image patches were used for training and evaluation. These image patches were resized into 224 × 224, 384 × 384, 512 × 512, and 768 × 768 pixels, and the differences in input size were analyzed. EfficientNet B0 was utilized as the convolutional neural network model. Gradient-weighted class activation mapping (Grad-CAM) was used to elucidate its validity.

Results

The proposed method achieved a peak accuracy of 99.65% with an input size of 512 × 512 pixels. Grad-CAM suggested that AI focused on both cellular and structural atypia of SCC, and tended to focus on the region surrounding the basal layer.

Conclusion

Training AI regarding both cellular and structural atypia using various magnification images simultaneously may be suitable for the diagnosis of oral SCC.

Prognostic Impact of Pattern of Mandibular Involvement in Gingivo-Buccal Complex Squamous Cell Carcinomas: Marrow and Mandibular Canal Staging System

PURPOSE

To study the pattern of mandibular involvement and its impact on oncologic outcomes in patients with gingivo-buccal complex squamous cell carcinoma (GBC-SCC) and propose a staging system based on the pattern of bone involvement (MMC: Marrow and mandibular canal staging system) and compare its performance with the 8th edition of the American Joint Committee on Cancer (AJCC8).

METHODS

This retrospective observational study included treatment-naïve GBC-SCC patients who underwent preoperative computed tomography (CT) imaging between January 1, 2012, and March 31, 2016, at a tertiary care cancer center. Patients with T4b disease with high infratemporal fossa involvement, maxillary erosion, and follow-up of less than a year were excluded. The chi-square or Fisher's exact test was used for descriptive analysis. Kaplan-Meier estimate and log-rank test were performed for survival analysis. Multivariate analysis was done using Cox regression analysis after making adjustments for other prognostic factors. p-Value <0.05 was considered as significant. Based upon the survival analysis with different patterns of bone invasion, a new staging system was proposed "MMC: Marrow and mandibular canal staging system". "Akaike information criterion" (AIC) was used to study the relative fitted model of the various staging (TNM staging-AJCC8) with respect to survival parameters.

RESULTS

A total of 1,200 patients were screened; 303 patients were included in the study. On radiology review, mandibular bone was involved in 62% of patients. The pattern of bone involvement was as follows: deep cortical bone erosion (DCBE) in 23%, marrow in 34%, and marrow with the mandibular canal in 43% of patients. Patients with DCBE and no bone involvement (including superficial cortical) had similar survival [disease-free survival (DFS) and locoregional recurrence-free survival (LRRFS)], and this was significantly better than those with marrow with or without mandibular canal involvement (for both DFS and LRRFS). Patients with DCBE were staged using the MMC, and when compared with the AJCC8, the MMC system was better for the prediction of survival outcomes, as AIC values were lower compared with those of the AJCC8. There was a significant association (p = 0.013) between the type of bone involvement and the pattern of recurrence.

CONCLUSIONS

For GBC-SCC, only marrow with or without mandibular canal involvement is associated with poorer survival outcomes. As compared with the AJCC8, the proposed Mahajan et al. MMC staging system downstages DCBE correlates better with survival outcomes.

Oral squamous cell carcinoma – clinical characteristics, treatment, and outcomes in a single institution retrospective cohort study

<b>Introduction:</b> Squamous cell carcinoma (SCC) is a common malignancy with high morbidity and mortality. </br></br> <b>Aim:</b> The aim of this study was to analyze the data of patients treated for malignant tumours of the oral cavity at the Department of Otolaryngology, Head and Neck Surgery, and Laryngological Oncology Ludwik Rydygier Collegium Medicum in Bydgoszcz between 2003–2011 to asses the influence of risk factors on survival in patients with squamous cell carcinoma of the oral cavity. </br></br> <b> Material and methods:</b> Material was collected from 62 patients treated for oral SCC between 2003–2011. Forty-three were men (69.35%) with a mean age of 56.33 years. The medical records were analysed, especially history, operative reports, histopathology reports, survival, adjuvant treatment and recurrence. </br></br> <b>Results:</b> All patients underwent surgical treatment (33.87% also had partial removal of the lower jaw, 67.74% adjuvant radio-therapy, 11.29% radiochemotherapy). More than half reported to the doctor within 6 to 15 weeks from the onset of symptoms. The majority smoked and drank alcohol (96.32%). Five-year disease specific survival (DSS) was 68.69%. </br></br> <b>Conclusions:</b> The age over 65 did not significantly influence DSS. The location on the anterior two thirds of the tongue gave the best outcome, while the worst outcome was observed in the retromandibular triangle area which was statistically almost significant (p = 0.06843). In the case of higher degrees of local and regional advancement and a higher stadium, a worse out-come was recorded. Positive surgical margins were identified in 11.29% of the cases, but they had no impact on the results of treatment. No worsening of the outcome was proven for the patients who reported to the doctor later than 15 weeks following the occurrence of symptoms.

TUBB3 immunostaining improves the diagnostic accuracy of oral liquid-based cytology in squamous cell carcinoma

OBJECTIVE

Although class III beta-tubulin (TUBB3) is not expressed in normal epithelium, its expression in cancers of some organs has been reported. Herein, we investigated TUBB3 expression pattern and level in oral squamous cell carcinoma (SCC), and assessed whether TUBB3 immunostaining could improve the diagnostic accuracy of oral scraping liquid-based cytology (LBC).

METHODS

Paraffin sections of biopsies from 107 patients with primary SCC and 30 patients with squamous papilloma occurred in tongue and gingiva were immunostained for TUBB3. Moreover, 15 LBC samples obtained from the study participants with SCC were also immunostained for TUBB3. Seven LBC samples were false-negative. TUBB3 expression level in each sample was evaluated and classified as 3+, 2+, 1+, and 0.

RESULTS

TUBB3 expression was confirmed in 91.6% of paraffin-embedded SCC specimens. Clear and diffuse positivity (above 2+) was observed in 77.6% of the total cases. In the well-differentiated type, tumour cells in the middle layer of the parenchyma specifically expressed TUBB3. In almost LBC samples, cancerous intermediate cells showed immunopositivity similarly to that of paraffin samples, even if cellular atypia was not clear in Papanicolaou staining.

CONCLUSIONS

TUBB3 immunostaining is useful for diagnosing oral SCC in scraping LBC, especially when samples consist of intermediate cells with little morphological change. Moreover, TUBB3 immunostaining could improve the diagnostic accuracy of oral scraping LBC by reducing false-negative.

Long non-coding RNA HOXA-AS3 promotes cell proliferation of oral squamous cell carcinoma through sponging microRNA miR-218-5p

Increasing evidence demonstrated long non-coding RNAs (lncRNAs) play important roles in the occurrence and development of oral squamous cell carcinoma (OSCC). This study aimed to explore the role and molecular mechanism of lncRNA HOXA-AS3 in the progression of OSCC. Here, we found that the expression of lncRNA HOXA-AS3 was upregulated in OSCC tissues and cell lines compared with the para-cancerous tissues and normal human oral keratinocyte (NHOK), respectively. Inhibition of HOXA-AS3 significantly inhibited the proliferation and colony formation of OSCC cells. Further, the luciferase reporter assay showed that HOXA-AS3 was directly bound to miR-218-5p. Moreover, the expression of miR-218-5p was negatively regulated by HOXA-AS3, and miR-218-5p could inhibit the expression of collagen type I alpha1 (COL1A1) and lysophosphatidylcholine acyltransferase 1 (LPCAT1). In addition, silencing miR-218-5p reversed the inhibitory effect of HOXA-AS3 knockdown on the proliferative potential of OSCC cells. In summary, our study illustrated that HOXA-AS3 promoted cancer cell proliferation in OSCC, possibly by sponging miR-218-5p for the first time, which provides a new target or a potential diagnostic biomarker for OSCC.

Prognostic value of non-smoking, non-alcohol drinking status in oral cavity cancer

OBJECTIVES

To compare the treatment response and prognosis of oral cavity cancer between non-smoking and non-alcohol-drinking (NSND) patients and smoking and alcohol-drinking (SD) patients.

METHODS

A total of 313 consecutively treated patients from 2000 to 2019 were included. Demographic, clinicopathologic, treatment, and prognosis information were obtained. Relapse-free survival (RFS), disease-specific survival (DSS), and overall survival (OS) were compared between NSND and SD groups using Kaplan-Meier plots, log-rank test, and multivariate Cox regression analysis.

RESULTS

Sample prevalence of NSND patients was 54.6%. These patients were predominantly females in their eighth decade with lower prevalence of floor of the mouth cancers compared to SD patients (1.8% vs 14.8%). No difference in the RFS and DSS between both groups was found following multivariable analysis; however, NSND patients had better OS (HR (95% CI) - 0.47 (0.29-0.75); p = 0.002). Extracapsular extension was associated with significantly poorer OS, DSS, and RFS in this oral cavity cancer cohort.

CONCLUSION

Treatment response and disease-specific prognosis are comparable between NSND and SD patients with oral cavity cancer. However, NSND patients have better OS.

CLINICAL RELEVANCE

This study shows that oral cavity cancer in NSND is not less or more aggressive compared to SD patients. Although better survival is expected for NSND than SD patients, this is likely due to the reduced incidence of other chronic diseases in the NSND group.

Multiple tumour recurrence in oral, head and neck cancer: Characterising the patient journey

BACKGROUND

Oral squamous cell carcinoma (OSCC) is the 15th most common cause of cancer-related mortality worldwide and approximately one oral cancer-related death occurs for every two new diagnoses. Death-due-to-disease is usually ascribed to inoperable primary tumours, treatment complications, second primary tumours arising due to field cancerization, or locoregional recurrence and distant metastases.

METHODS

A retrospective review of OSCC patients treated over a 19-year period, betweenOctober 1^st , 2000 and October 1^st , 2019. Patient demographic records were collected from consecutively treated adult patients with clinical subtypes corresponding to ICD-10 C00-C06, C09 and C10 were retrieved from the database. Patients who had suffered three or more recurrences after diagnosis of the primary tumour are defined as multiple-recurrent patients.

RESULTS

A total of 467 OSCC patients were treated during the study period. One hundred and fifty-five patients developed recurrent OSCC, amongst which 22 were designated as multiple cases. The time between initial OSCC diagnosis and first tumour recurrence varied from 3 to 276 months. Nine of the 22 multiple patients (41%) were diagnosed with buccal mucosal SCC as the primary tumour, which is significantly higher than the average prevalence (or 4.4, 95% CI (1.8, 10.8), p < 0.001) for buccal tumours within the cohort. All patients were treated initially by surgical tumour excision. There were no demonstrable differences in adjuvant chemo-radiotherapy regimes in any of the study groups.

CONCLUSION

Multiple OSCC development may occur either synchronously or metachronously during the course of oral cancer disease and poses an important management problem in contemporary oncology practice.