Clinicopathological characteristics of oral squamous cell carcinoma in Northern Norway: a retrospective study

Demographic and imaging features of oral squamous cell cancer in Serbia: a retrospective cross-sectional study

BACKGROUND

The mortality of oral squamous cell cancer (OSCC) in Serbia increased in the last decade. Recent studies on the Serbian population focused mainly on the epidemiological aspect of OSCC. This study aimed to investigate the demographic and imaging features of OSCC in the Serbian population at the time of diagnosis.

METHODS

We retrospectively analyzed computed tomography (CT) images of 276 patients with OSCC diagnosed between 2017 and 2022. Age, gender, tumor site, tumor volume (CT-TV, in cm3), depth of invasion (CT-DOI, in mm), and bone invasion (CT-BI, in %) were evaluated. TNM status and tumor stage were also analyzed. All parameters were analyzed with appropriate statistical tests.

RESULTS

The mean age was 62.32 ± 11.39 and 63.25 ± 11.71 for males and females, respectively. Male to female ratio was 1.63:1. The tongue (36.2%), mouth floor (21.0%), and alveolar ridge (19.9%) were the most frequent sites of OSCC. There was a significant gender-related difference in OSCC distribution between oral cavity subsites (Z=-4.225; p < 0.001). Mean values of CT-TV in males (13.8 ± 21.5) and females (5.4 ± 6.8) were significantly different (t = 4.620; p < 0.001). CT-DOI also differed significantly (t = 4.621; p < 0.001) between males (14.4 ± 7.4) and females (10.7 ± 4.4). CT-BI was detected in 30.1%, the most common in the alveolar ridge OSCC. T2 tumor status (31.4%) and stage IVA (28.3%) were the most dominant at the time of diagnosis. Metastatic lymph nodes were detected in 41.1%.

CONCLUSION

Our findings revealed significant gender-related differences in OSCC imaging features. The predominance of moderate and advanced tumor stages indicates a long time interval to the OSCC diagnosis.

Anatomical landscape of oral squamous cell carcinoma: A single cancer center study in UAE

Objectives

This study aimed to present demographic and clinicopathological aspects of OSCC identified in Pathology service in the UAE over a 13-year period and compare these findings to a cohort of 523 cases of Head and neck squamous cell carcinoma using the Cancer Genome Atlas's cBioPortal database (http://cbioportal.org).

Material and methods

Histological examination of all hematoxylin and eosin-stained slides and assessment of all demographic and clinical information from laboratory records were performed on all OSCC diagnosed between 2005 and 2018.

Results

Males made up 71.4% of the sample of 231 OSCCs that were evaluated. The patients' average age was 55.38 years. The two most prevalent afflicted sites were the anterior two-thirds of the tongue (57.6%) and the cheek (28.1%). The most prevalent site among smokers were the floor of mouth, cheek, and jaw bones. There was a link between tumor size and numerous anatomical subsites that was shown to be highly significant. OSCC in the FOM was associated with a 25% mortality rate. Patients with OSCC of the anterior tongue and cheek had the best prognosis, with only 15.7% and 15.3% of patients dying during follow-up.

Conclusion

The present investigation found a correlation between the diverse clinicopathological characteristics of the various anatomical subsites in OSCC. Different anatomical subsites also displayed varying degrees of gene mutation.

Modifiable risk factors for oral cavity cancer in non-smokers: A systematic review and meta-analysis

BACKGROUND

Oral cavity cancer (OCC) is traditionally associated with smoking, but there is an increasing prevalence of the disease among non-smokers. This review investigates possible modifiable risk factors in the development of OCC in non-smokers (OCCNS).

METHODS

PubMed, EMBASE, Web of Science, and Scopus were searched for publications prior to June 2021. Comparative studies investigating modifiable OCCNS risk factors were identified following PRISMA guidelines. Publication date, population size, and results were indexed. Study quality was assessed using MINORS (Methodological Index for Non-Randomized Studies). Factors examined by multiple studies were analyzed using random-effect meta-analysis framework.

RESULTS

Literature search resulted in 1,625 unique publications. 52 records met inclusion criterion, investigating alcohol (n = 22), chewing products (n = 18), diet (n = 7), dental health (n = 11), and medical comorbidities (n = 6).

CONCLUSION

This review demonstrates the paucity of large studies investigating OCCNS risk factors. Further investigation is warranted to help clinicians risk-stratify patients without traditional risk factors.

Impact of histological tumor grade on the behavior and prognosis of squamous cell carcinoma of the oral cavity

INTRODUCTION

Unlike other types of cancers, the prognostic value of histological tumor grade is not well determined for oral squamous cell carcinoma (OSCC). This study therefore aimed to evaluate the impact of tumor differentiation on prognosis and overall survival of patients affected by squamous cell carcinoma of the oral cavity.

MATERIALS AND METHOD

A retrospective analysis was conducted using the records of patients diagnosed with squamous cell carcinoma of the oral cavity between 2010 and 2015. The study included 162 patients treated with a tumorectomy and selective neck dissection. The influence of histological tumor grade on several prognostic factors such as T-Stage, N-stage, recurrence rate, perineural invasion, vascular invasion, surgical margins, and overall survival was analyzed.

RESULTS

Histological grade strongly correlated with N-stage, recurrence rate, perineural invasion, vascular invasion, surgical margins, and overall survival. Overall survival was 71.6% in patients with well-differentiated tumors and 43.2% in those with moderately and poorly differentiated tumors.

CONCLUSIONS

Histological grade represents an important prognostic factor for OSCC. Therefore, various treatment strategies based on this histological parameter could improve the overall survival rate of patients affected by oral squamous cell carcinoma.

Oroxylum indicum Stem Bark Extract Reduces Tumor Progression by Inhibiting the EGFR-PI3K-AKT Pathway in an In Vivo 4NQO-Induced Oral Cancer Model

OBJECTIVES

Oral squamous cell carcinoma (OSCC) is the predominant type of oral cancer. Its incidence is high in certain geographic regions, and it is correlated with chewing tobacco. Epidermal growth factor receptor (EGFR), induced by tobacco carcinogens, is overexpressed in OSCC, leading to poor prognosis. Thus, EGFR inhibitors are promising agents against OSCC. High cost and toxicity of existing EGFR inhibitors necessitate alternative EGFR-targeted therapy. Here, we tested the antitumor potential of ethyl acetate fraction of an ethnomedicinal tree, Oroxylum indicum stem bark extract (OIEA) in a 4-nitroquinoline-1-oxide (4NQO)-induced oral carcinogenesis model.

METHODS

OIEA was prepared by solvent extraction method, and subsequently its in vitro radical scavenging activities were measured. High-performance liquid chromatography (HPLC) analysis of OIEA was done to identify the constituent active compounds. Hemolytic, trypan blue exclusion, and MTT [3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium Bromide] assays were performed in normal and cancer cells to select an optimum dose of OIEA for antitumor activity study in 4NQO-induced oral cancer in F344 rats. Measurement of tumor volume, weight, and cell count was followed by tumor cell cycle analysis and comet and annexin V/Propidium Iodide (PI) assay. Pro-apoptotic markers were detected by western blot testing. Molecular docking was done to predict the interaction between OIEA active component and EGFR or phosphatidylinositol-3-kinase (PI3K), which was further validated biologically. Finally, hepatic and renal function testing and histopathology were performed.

RESULTS

OIEA reduced tumor burden and increased survivability of the tumor-bearing rats significantly as compared to untreated tumor bearers. HPLC revealed oroxylin A as the predominant bioactive component in OIEA. Molecular docking predicted significant binding between oroxylin A and EGFR as well as PI3K, which was confirmed by western blot analysis of in vivo samples. OIEA also ameliorated hepato-, renal- and myelotoxicity induced by 4NQO.

CONCLUSION

OIEA reduces 4NQO-induced OSCC by modulating the EGFR/PI3K/AKT signaling cascade and also ameliorated toxicity in tumor bearers.

Reexamination of delays in diagnosis of oral cancer following an intervention program in Cordoba, Argentina

OBJECTIVE

We compare the results of delay in oral cancer diagnosis before and after a campaign directed toward dentists and raising awareness of the population to achieve early diagnosis of oral cancer in Córdoba, Argentina. The campaign included training dentists in diagnostic skills and a public awareness program through media and networks.

STUDY DESIGN

Clinical records (period 1: before intervention program, n = 70; period 2: after intervention program, n = 60) of patients presenting with oral squamous cell carcinoma treated in 2 referral centers were analyzed. Records included first symptoms, first consultation with a health professional, and the time when treatment was formulated.

RESULTS

Oral cancer diagnosis at early stages increased from 27% (period 1) to 40% (period 2). Biopsy at first consultation was indicated in 6% of patients in period 1 and in 23.3% in period 2 (odds ratio = 4.68; 95% confidence interval, 1.87-11.73; P < .05). Professional delay at early stage decreased from 72% in period 1 to 36.8% in period 2. During period 1, for initial stage cancer, the average patient and professional delays were 2.7 and 2.9 months, respectively (P = .06); in period 2, patient delay was 2.67 months and professional delay was 1.34 months (P = .005).

CONCLUSION

The intervention program helped to improve early-stage diagnosis from 27% to 40% by reducing professional delays.

Association between Sarcopenia and Immediate Complications and Mortality in Patients with Oral Cavity Squamous Cell Carcinoma Undergoing Surgery

Simple Summary

Surgery remains the mainstay treatment for oral cavity squamous cell carcinoma (OSCC). Up to 40% of patients with OSCC experience postoperative complications, most within the first 30 days since surgery. The early detection of postoperative complications is challenging. Sarcopenia has been shown to be a negative predictor of the surgical and oncological outcomes of patients with OSCC. The effect of sarcopenia associated with immediate complications and impaired survival after surgery for OSCC is still unknown. This study comprehensively investigated the clinical risk factors and biomarkers associated with 30-day postoperative complications and 5- and 8-year survival of patients with OSCC. Sarcopenia was an independent risk factor associated with 30-day complications, increased reoperation rate, and reduced short- and long-term overall and disease-free survival. Sarcopenia should be assessed before surgery to identify high-risk patients who require a more intensive approach to minimize complications and may be clinically helpful in tailoring treatment strategies for patients with OSCC.

Abstract

Sarcopenia negatively affects oncologic outcomes. However, studies have yet to reveal whether it is associated with postoperative complications and survival among patients with oral cavity squamous cell carcinoma (OSCC). This study retrospectively enrolled 592 patients undergoing primary OSCC surgery with available computed tomography (CT) images of their third cervical vertebrae (C3) within 30 days before surgery between January 2011 and December 2020. Preoperative sarcopenia, nutritional and frailty status, tumor characteristics, comorbidities, and inflammatory markers were assessed. The outcome variables included 30-day complications based on the Buzby and Dindo classification, reoperation, 5- and 8-year overall survival, and disease-free survival. A total of 318 (53.7%) had sarcopenia; of these patients, 217 (68.2%) presented with postoperative complications, and 48 (15.1%) underwent reoperations. Sarcopenia and higher systemic immune-inflammatory index were independently associated with local to systemic 30-day complications. Sarcopenia, advanced-stage disease, and extracapsular spread were correlated with 5- and 8-year survival. The presence of sarcopenia is associated with the 30-day complications and short- and long-term survival of patients who had OSCC and underwent surgery.

Tobacco use in patients with ENT tumours: Deficits in the provision of education and smoking cessation support

PURPOSE

Smoking is not only one of the main risk factors for the development of most malignant and numerous benign ENT tumours but also has an important influence on therapy and prognosis. Even quitting smoking at the time of diagnosis significantly reduces mortality. Patients have a particularly strong desire to stop smoking when they are diagnosed. The present study investigated to what extent patients were aware of the relationships between smoking and the development and prognosis of tumours and how much information and smoking cessation support they were offered by physicians.

METHODS

A total of 194 patients (74.7% male, 62.0 ±10.6 a) with malignant primary ENT tumours, pre-cancerous tumours, Reinke's oedema and salivary gland tumours were interviewed.

RESULTS

22.7% were nonsmokers, 49.5% were cigarette smokers and 27.8% were ex-smokers. A total of 57.0% of the smokers said they would have quit before the onset of the disease if they had known about the association. Forty-one percent did not receive information about the association between smoking and the development of their disease, while 45.5% did not receive information about the relationship with their prognosis. The provision of information lasted less than 5 min for 40.4% of the patients and more than 10 min for only 13.5%. In total, 50.7% of the patients were directly requested not to smoke. A total of 7.7% received offers of smoking cessation support from otolaryngologists and 18.2% received such offers from family physicians.

CONCLUSIONS

There is a pronounced need for improvements in the provision of medical information about the health risks associated with smoking and offers to support patient efforts to stop smoking. In particular, the appointment during which the diagnosis is communicated to the patient should be considered a 'teachable moment' that can lead to smoking cessation.

A Novel Autophagy-Related Prognostic Risk Model and a Nomogram for Survival Prediction of Oral Cancer Patients

Background. This study is aimed at constructing a risk signature to predict survival outcomes of ORCA patients. Methods. We identified differentially expressed autophagy-related genes (DEARGs) based on the RNA sequencing data in the TCGA database; then, four independent survival-related ARGs were identified to construct an autophagy-associated signature for survival prediction of ORCA patients. The validity and robustness of the prognostic model were validated by clinicopathological data and survival data. Subsequently, four independent prognostic DEARGs that composed the model were evaluated individually. Results. The expressions of 232 autophagy-related genes (ARGs) in 127 ORCA and 13 control tissues were compared, and 36 DEARGs were filtered out. We performed functional enrichment analysis and constructed protein–protein interaction network for 36 DEARGs. Univariate and multivariate Cox regression analyses were adopted for searching prognostic ARGs, and an autophagy-associated signature for ORCA patients was constructed. Eventually, 4 desirable independent survival-related ARGs (WDR45, MAPK9, VEGFA, and ATIC) were confirmed and comprised the prognostic model. We made use of multiple ways to verify the accuracy of the novel autophagy-related signature for survival evaluation, such as receiver-operator characteristic curve, Kaplan–Meier plotter, and clinicopathological correlational analyses. Four independent prognostic DEARGs that formed the model were also associated with the prognosis of ORCA patients. Conclusions. The autophagy-related risk model can evaluate OS for ORCA patients independently since it is accurate and stable. Four prognostic ARGs that composed the model can be studied deeply for target treatment.

Combined loss of expression of involucrin and cytokeratin 13 is associated with poor prognosis in squamous cell carcinoma of mobile tongue

BACKGROUND

This study aimed to evaluate the prognostic significance of expression levels of involucrin (IVL), cytokeratin (CK)-10 and -13 at different intratumor sites (tumor center and invading area) of oral tongue squamous cell carcinoma (OTSCC).

METHODS

IVL, CK13 and CK10 expression levels were examined in a multicenter cohort of 146 OTSCCs using immunohistochemistry. External mRNA datasets were used for expression analysis and/or to validate survival associations.

RESULTS

External transcriptomic datasets showed downregulation of IVL and KRT13 in oral malignancies including OTSCC as compared to normal controls. The combined loss of IVL and CK13 expression at the invading core but not at the center core was significantly associated with poor differentiation and reduced 5-year overall survival. Multivariate Cox analysis confirmed the loss of CK13 and IVL expression to be an independent prognostic factor. Transcriptomic dataset corroborated immunohistochemistry results.

CONCLUSIONS

Combined expression levlels of IVL and CK13 might be useful as prognostic biomarkers in OTSCC.

"Fact or fiction?": Oral cavity cancer in nonsmoking, nonalcohol drinking patients as a distinct entity-Scoping review

Oral cavity cancer is often described as a lifestyle-related malignancy due to its strong associations with habitual factors, including tobacco use, heavy alcohol consumption, and betel nut chewing. However, patients with no genetically predisposing conditions who do not indulge in these risk habits are still being encountered, albeit less commonly. The aim of this review is to summarize contemporaneous reports on these nonsmoking, nonalcohol drinking (NSND) patients. We performed database searching to identify relevant studies from January 1, 2000 to March 31, 2021. Twenty-six articles from 20 studies were included in this study. We found that these individuals were mostly females in their eighth decade with tumors involving the tongue and gingivobuccal mucosa. This review also observed that these patients were likely diagnosed with early stage tumors with overexpression of programmed death-ligand 1 (PD-L1) and increased intensity of tumor infiltrating lymphocytes. Treatment response and disease-specific prognosis were largely comparable between NSND and smoking/drinking patients.

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.

Impact of Astroprincin (FAM171A1) Expression in Oral Tongue Cancer

Astroprincin (APCN, FAM171A1) is a recently characterized transmembrane glycoprotein that is abundant in brain astrocytes and is overexpressed in some tumors. However, the expression and role of APCN is unknown in oral tongue squamous cell carcinoma (OTSCC). Aim of this study was to investigate the expression of APCN in OTSCC tissue samples and to analyze possible association of APCN with clinicopathological features and survival rates. This study included 76 patients treated for OTSCC. Expression of APCN in OTSCC tissue sections was examined by immunohistochemistry with a rabbit polyclonal antibody (MAP346) against APCN. All tumors were scored for intensity and percentage of APCN staining at the superficial, middle, and invasive front areas. High expression of APCN was significantly associated with increased tumor size (P = 0.013) and with OTSCC recurrence (P = 0.026). In this pilot study, we observed that the amount of APCN is associated with the size and recurrence of OTSCC. This finding suggests a role of APCN during OTSCC progression.

Analysis of primary oral and oropharyngeal squamous cell carcinoma in inhabitants of Beijing, China-a 10-year continuous single-center study

Background

This study aimed to describe some of the characteristics of the inhabitants of Beijing with oral and oropharyngeal squamous cell carcinoma (OSCC) who had received treatment at the Stomatology Hospital of Peking University and to analyze the survival rate and the prognostic factors of patients following surgical treatment.

Methods

Data for 603 consecutive cases with primary OSCC between 2004 and 2013 were obtained from the Stomatology Hospital of Peking University. Clinical data including age, sex, living district, primary tumor site, TNM stage, history of drinking and smoking, pathological differentiation, treatment, and survival were retrospectively analyzed.

Results

The male:female ratio was 1.1:1. The frequency of site involvement in descending order was tongue (34.3%), gingiva (25.0%), buccal mucosa (13.8%), oral floor (9.0%), oropharynx (8.5%), lip (6.3%) and palate (3.2%). Female OSCC patients tended to be significantly older than men with OSCC (P < 0.05). The percentage of patients with TNM stage III–IV OSCC was 52.4%. The results revealed that 65.3% of male patients and only 6.3% of female patients smoked or drank. The overall 5-year survival rate was 64%. Female patients had a worse prognosis than male patients. Among the patients who received surgery, tumor size and lymph node involvement were independent prognostic factors. Smoking and drinking were not prognostic factors.

Conclusion

Among the Beijing inhabitants who were diagnosed with OSCC and treated in our hospital in the past 10 years, more than half were in the advanced stage, and the cancer stage was the main prognostic factor of oral cancer. Therefore, the recognition of oral cancer should be strengthened, and early detection and treatment of OSCC should be achieved to improve the survival rate.

Characteristics and prognosis of primary treatment-naïve oral cavity squamous cell carcinoma in Norway, a descriptive retrospective study

Objectives

Incidence of oral cavity squamous cell carcinomas is rising worldwide, and population characterization is important to follow for future trends. The aim of this retrospective study was to present a large cohort of primary oral cavity squamous cell carcinoma from all four health regions of Norway, with descriptive clinicopathological characteristics and five-year survival outcomes.

Materials and methods

Patients diagnosed with primary treatment-naïve oral cavity squamous cell carcinomas at all four university hospitals in Norway between 2005–2009 were retrospectively included in this study. Clinicopathological data from the electronic health records were compared to survival data.

Results

A total of 535 patients with primary treatment-naïve oral cavity squamous cell carcinomas were identified. The median survival follow-up time was 48 months (range 0–125 months) after treatment. The median five-year overall survival was found to be 47%. Median five-year disease-specific survival was 52%, ranging from 80% for stage I to 33% for stage IV patients. For patients given treatment with curative intent, the overall survival was found to be 56% and disease-specific survival 62%. Median age at diagnosis was 67 years (range 24–101 years), 64 years for men and 72 years for women. The male: female ratio was 1.2. No gender difference was found in neither tumor status (p = 0.180) nor node status (p = 0.266), but both factors influenced significantly on survival (p<0.001 for both).

Conclusions

We present a large cohort of primary treatment-naïve oral cavity squamous cell carcinomas in Norway. Five-year disease-specific survival was 52%, and patients eligible for curative treatment had a five-year disease-specific survival up to 62%.

Oral Potentially Malignant Disorders and Squamous Cell Carcinoma at the Tongue: Clinicopathological Analysis in a Thai Population

Objective  Tongue is regarded as one of the common sites of oral squamous cell carcinoma (OSCC). This study aimed to determine the prevalence and clinicopathological profile of OSCC and oral potentially malignant disorders (OPMDs) at the tongue.

Materials and Methods  We retrospectively analyzed clinicopathological characteristics of 208 Thai patients diagnosed with SCC and OPMDs at the tongue in the period from 1996 to 2015. Chi-squared test was used to compare differences between patient’s clinical and histopathological features.

Results  Seventy-eight tongue SCC and 130 tongue OPMD cases were present over the study period. Slight male predominance was found for tongue SCC, while a slight female predominance was present for tongue OPMDs. Both tongue SCC and tongue OPMDs were mostly diagnosed in the old age patients (>40 years old). The majority of tongue SCC and OPMDs occurred at the tip and lateral of the tongue. The most common histologic grading of tongue SCC was well differentiated and no poor differentiation was found in this study. More than a half of tongue OPMDs showed epithelial dysplasia. Both tongue SCC and OPMDs demonstrated no significant correlation between clinical feature and histopathologic diagnosis.

Conclusions  Tongue SCC and OPMDs were particularly found in the elderly population and frequently developed at the tip and lateral of the tongue. Most of tongue OPMDs, particularly all of tongue erythroplakia, exhibited epithelial dysplasia. For dental practitioners, awareness in the early detection and diagnosis of these tongue lesions should be raised.

Oral Cancer Knowledge, Attitude, and Practice of Dentists in the State of Qatar

Objectives: The aim of this study was to assess existing knowledge on oral cancer (OC), attitude toward OC examination, and clinical practice among dentists practicing in the governmental health sector in the State of Qatar, including the influence of personal characteristics. Materials and Methods: All 271 dentists practicing in Primary Health Care Centers (PHCC) and the Hamad Medical Corporation (HMC) were invited to participate in this cross-sectional study. Of these, 177 completed a self-administered, 48-item questionnaire. Based on the responses, knowledge of the risk factors for and clinical presentation of OC was categorized as high, medium, or low, and then further separated into satisfactory (medium/high) and unsatisfactory (low). Information on attitudes toward OC examination and clinical practice was also taken from the questionnaire. Results: The mean score for knowledge of the clinical presentation of OC was 7.59 (standard deviation [SD] = 2.40) out of 14. The mean score for knowledge of the risk factors for OC was 8.96 (SD = 2.31) out of 16. Dentists with ≤10 years of experience were more likely to have satisfactory knowledge of OC compared to dentists with >15 years of experience. Attending a continuous professional development (CPD) course on OC showed a trend with satisfactory clinical knowledge, although it was not statistically significant. Conclusion: This study identified gaps in dentists’ knowledge of OC; dentists demonstrated unsatisfactory knowledge of the clinical presentation of and risk factors for OC. The findings highlighted the need for educational interventions on OC, which are essential to improving health care outcomes and delivery of care.

Profile of patients and factors related to the clinical staging of oral squamous cell carcinoma

OBJECTIVE

The aim of the present study was to identify the profile of patients diagnosed with oral squamous cell carcinoma (SCC) and factors associated with the clinical stage of the disease.

MATERIALS AND METHOD

A cross-sectional study was conducted with a sample of 293 medical charts of patients with SCC treated at an oncology reference center in the city of Campina Grande (Brazil) between 2000 and 2006. Descriptive and inferential statistics were performed with robust Poisson regression (α=5%).

RESULTS

Males (56.6%), non-white individuals (49.0%) and individuals over than 60 years of age (74.1%) were the most affected by SCC. The tongue (35.1%) and palate (21.5%) were the most common sites. A large portion of the patients were smokers (37.6%) and 60.2% were in an advanced stage of the disease. Clinical staging was not associated with sex, age, skin color or drinking and/or smoking habits.

CONCLUSION

There was a higher incidence of SCC in men, older patients, non-white individuals and smokers. Clinical staging was not associated with the variables analyzed.

What do dental college clinicians know about oral cancer and its risk factors? An assessment among final year students, interns and faculty members in saudi arabia

Background

The ability of health care professionals to perform oral cancer examination depends partly on their knowledge of the disease and its risk factors. This study aimed to assess and compare the knowledge of final year students, interns and faculty members regarding oral cancer and its risk factors.

Material and Methods

A 35-item questionnaire about knowledge of oral cancer and its risk factors was distributed among participants from Jazan University’s Dental School. A minimum score of 18 was the cut-off point for an acceptable total score of oral cancer knowledge [OCTS]. Descriptive statistics described the relations between demographics variables and knowledge levels of participants. The differences between OCTS, diagnostic-clinical examination knowledge [DCK] and supportive knowledge [SK] and sex and occupation were analyzed using independent t-test and ANOVAs respectively.

Results

A total of 72 students, 68 interns and 88 faculty members completed the questionnaires (N = 228); with an average age of 23.8 ± 0.9 years, 25.1 ± 1.5 years and 40.6 ± 9.1 years with 55.1% males. OCTS was 20.2 ± 3.6 out of 35. No significant difference between OCTS and participants’ sex was found (t (203) = 1.342, p = .181, 95% CI for difference -.302 ــ 1.589). No significant differences in OCTS between students, interns and faculty members (F (2, 225) = 2.116, p = .123). A significant difference in SK between final year students, interns, and faculty members was founded (F (2, 194) = 5.62, p = .004).

Conclusions

Knowledge of oral cancer and its risk factors among Jazan Dental School’s final year students, interns and faculty members is acceptable. However, due to the high rate of oral cancer in Jazan, emphasizing knowledge of oral cancer and its risk factors in the curriculum of Jazan Dental School is required.

Key words:Oral cancer, risk factors, knowledge, dental education, curriculum, dental students, dentists.

Presence of high-endothelial venules correlates with a favorable immune microenvironment in oral squamous cell carcinoma

Oral squamous cell carcinomas are associated with a poor prognosis, which may be partly due to functional impairment of the immune response. Lymphocyte recruitment to the tumor site is facilitated by high-endothelial venules, whereas expression of programmed-death ligand 1 (PD-L1) can impair T-cell function. Thus, we hypothesize that these factors are important in shaping the immune response in oral squamous cell carcinoma. In the present study, we characterized the immune infiltrate in formalin-fixed, paraffin-embedded tumor samples from 75 oral squamous cell carcinoma patients. We used immunohistochemistry to determine the distribution of immune cell subsets, high-endothelial venules, and PD-L1, as well as quantitative real-time polymerase chain reaction to assess the expression of inflammatory cytokines and chemokines associated with lymphocyte trafficking. Finally, we calculated correlations between the presence of immune cell subsets, the gene expression patterns, high-endothelial venules, PD-L1, and the clinicopathological parameters, including patient survival. The presence of high-endothelial venules correlated with increased number of CD3+ T cells and CD20+ B cells, higher levels of the chemokines CXCL12 and CCL21, and lower levels of CCL20, irrespective of the tumors' T stage. In univariate analysis, high levels of CD20+ B cells and CD68+ macrophages, positive high-endothelial venule status, and low T and N stages predicted longer patient survival. However, only the presence of high-endothelial venules and a low T stage were independent positive prognosticators. This indicates that high-endothelial venules are important mediators and a convenient marker of an antitumor immune response in oral squamous cell carcinoma. Our findings suggest that these vessels are a potential immunomodulatory target in this type of cancer. PD-L1 staining in tumor cells correlated with lower T stage, increased infiltration of CD4+ cells, and higher expression of several inflammation-related cytokines. Thus, oral squamous cell carcinomas rich in CD4+ cells may preferentially respond to PD-1/PD-L1 blockade therapy.

Oral squamous cell carcinoma: a clinicopathological study on 194 cases in northeastern Brazil. A cross-sectional retrospective study

BACKGROUND

Only a few studies have evaluated the clinicopathological features of oral squamous cell carcinoma (SCC) in Brazil, and most were conducted in the most industrialized region of the country, i.e. the southeastern region. The aim of this study was to evaluate the clinicopathological features of this malignant neoplasm in northeastern Brazil.

DESIGN AND SETTING

Retrospective study performed in an oral pathology laboratory in Recife, Brazil.

METHODS

All cases of oral SCC that occurred between 2000 and 2015 were studied. Clinical data were recorded and histological slides were reviewed. Statistical analysis was performed using the chi-square test (P ≤ 0.05).

RESULTS

A total of 194 cases were evaluated. The male-to-female ratio was 1.5:1. The mean age was 65.4 years, and only 6.6% of the cases occurred in patients younger than 41 years. Most tumors consisted of well-differentiated SCC (54.6%).

CONCLUSIONS

The findings of this study highlight the higher prevalence of oral SCC among women and the increasing number of cases among young patients. Thus there is no specific risk group for oral SCC, as in the past. This fact needs to be taken into consideration in clinical routine care, so that apparently innocuous malignant lesions do not go unnoticed in these individuals.

Pathological features and their prognostic impacts on oral cavity cancer patients among different subsites - A singe institute's experience in Taiwan

We investigated the relationship of different primary subsites together with their pathological features on the survival of oral cavity squamous cell carcinoma (OCSCC) patients. We retrospectively reviewed OCSCC patients and documented their demographic data, pathological features and clinical outcome. The Cox proportional hazard model was used to examine the influence of various pathological features on the prognosis in different subsites of oral cavity. There were totally 1,383 OCSCC patients enrolled for final analysis. Perineural invasion had a poor prognosis at the early stage of OCSCC patients especially those with primary at the tongue. In addition, lymphovascular invasion was associated with poor survival at the late stage especially those with primary at the buccal mucosa and the tongue. The impact of pathological features on the survival of OCSCC patients varied in different subsites. Further investigation is warranted to validate our finding in a multicenter study. Grouping the different markers to establish a prognostic scoring system may provide more accurate evaluation of the prognosis in OCSCC patients.

Improving accuracy of RNA-based diagnosis and prognosis of oral cancer by using noninvasive methods

RNA-based diagnosis and prognosis of squamous cell carcinoma has been slow to come to the clinic. Improvements in RNA measurement, statistical evaluation, and sample preservation, along with increased sample numbers, have not made these methods reproducible enough to be used clinically. We propose that, in the case of squamous cell carcinoma of the oral cavity, a chief source of variability is sample dissection, which leads to variable amounts of stroma mixed in with tumor epithelium. This heterogeneity of the samples, which requires great care to avoid, makes it difficult to see changes in RNA levels specific to tumor cells. An evaluation of the data suggests that, paradoxically, brush biopsy samples of oral lesions may provide a more reproducible method than surgical acquisition of samples for miRNA measurement. The evidence also indicates that body fluid samples can show similar changes in miRNAs with oral squamous cell carcinoma (OSCC) as those seen in tumor brush biopsy samples - suggesting much of the miRNA in these samples is coming from the same source: tumor epithelium. We conclude that brush biopsy or body fluid samples may be superior to surgical samples in allowing miRNA-based diagnosis and prognosis of OSCC in that they feature a rapid method to obtain homogeneous tumor cells and/or RNA.

The relationship between histological differentiation and disease recurrence of primary oral squamous cell carcinoma

Background:

Although advance techniques were available for diagnosis and prognosis of oral cancer, histopathology was used as major method in clinical routine. Of all oral subsites, buccal mucosa squamous cell carcinoma is aggressive in nature with poor survival. Therefore, the aim of the present study was to evaluate the relation of tumor histopathological grade with disease recurrence of buccal squamous cell mucosa carcinoma.

Materials and Methods:

A retrospective study was carried out in regional cancer research institute, Tamil Nadu. Demographic, histopathological and participant's follow-up details were collected from medical records.

Results:

Of 198 participants, high frequently encountered with well-differentiated squamous cell carcinoma (n = 98, 49.5%). The clinical characteristics of lymphovascular invasion (P = 0.031), perineural invasion (P = 0.019), tumor stage (P = 0.004), tumor depth (P = 0.048), lymph node (P = 0.02) and metastasis (P = 0.043) had significant association with histopathological grade. In addition, the treatment strategies (P = 0.014) also showed significance at P < 0.05. Further, multivariate revealed cell differentiation (P = 0.048), tumor size (P = 0.037) and depth (P = 0.021) as independent hazard risk of the development of disease using recurrence-free survival of participants at P < 0.05. Of 198 participants, 24 (12.1%) recurrences reported during 34-month follow-up period and the overall estimated recurrence-free survival was 52%. The high frequency of recurrence, 12 (50%), was identified with moderately differentiated tumor cells. However, poorly differentiated tumor showed significantly lower survival (28%) than moderate (54%) and well differentiated (81%) by Kaplan–Meier analysis using log-rank test (P = 0.004, P < 0.05).

Conclusions:

The present study concludes high frequency of recurrence observed in moderately differentiated and also revealed lower survival in poorly differentiated tumor. Hence, further treatment plans should focus on moderate and poorly differentiated tumors to improve survival outcome.

The use of adjunctive traditional Chinese medicine therapy and survival outcome in patients with head and neck cancer: a nationwide population-based cohort study

BACKGROUND

Traditional Chinese medicine (TCM) is widely used in the treatment of patients with several types of cancer. However, no large-scale clinical studies have evaluated whether TCM is associated with better survival in patients with head and neck cancer (HNC).

METHODS

The Taiwan National Health Insurance Research Database was used to conduct a retrospective cohort study of patients with HNC between 2001 and 2011. The patients with HNC were separated into TCM users and non-users, and Cox regression models were applied to determine the association between the use of TCM and survival outcome.

RESULTS

The TCM and comparison cohorts comprised data for 2966 and 2670 patients, respectively. The mean age was 51.3 years in the TCM cohort and 51.7 years in the comparison cohort. Multivariate analysis demonstrated that the use of TCM was significantly associated with lower risk of all-cause mortality by 32% (adjusted hazard ratio, 0.68; 95% confidence interval, 0.62-0.75). Patients with longer TCM use had a lower mortality rate (P for trend < 0.001).

CONCLUSIONS

Our study showed that adjunctive therapy with TCM is associated with higher survival outcome. However, some limitations exist, such as the lack of information of cancer stage. In addition, causality cannot be assessed with this retrospective study. A randomized controlled trial to test the effect of adjunctive TCM therapy in HNC patients is needed.