Oral Squamous Cell Carcinomas are Associated with Poorer Outcome with Increasing Ages.

OBJECTIVES: 1.1.Although oral cancers traditionally occur in people between the age of 50 and 70, there are increasing incidences of this disease in younger and very old people. Objectives: to compare the demographics, habits, clinicopathological features, treatment and outcome of oral cancer in three age groups of patients: Young (≤ 45), Traditional (46 to 75), and Old (> 75). SUBJECTS: 1.2.Primary oral cancers (393 patients) in a longitudinal study were used. RESULTS: 1.3.Significant differences were noted in ethnicity (fewer Caucasian patients in Young), tobacco habit (more non-smokers in Young), location of cancer (more at tongue for Young and more at low-risk sites for Old) and treatment (more surgery for Young). Compared to Young (univariate analysis), Traditional and Old showed a 3- and 4.5-fold increase in local recurrences respectively; 1.9- and 2.7-fold increase in regional metastasis; 3.1- and 5.4-fold increase in death due to disease; and a 3.4- and 6.6-fold decrease in overall survival. Compared to Young (multivariate analysis), Traditional and Old showed a 2.4- and 3.3-fold increase in local recurrence; 2.7- and 5.4-fold increase in disease-specific survival; and 2.8- and 6.5-fold decrease in overall survival. CONCLUSION: 1.4.Oral cancer in different age groups showed differing ethnicity, habit, location, treatment and outcome.

Should severe epithelial dysplasia be treated?

OBJECTIVE: To identify clinical features associated with progression of primary severe epithelial dysplasia into invasive squamous cell carcinoma (SCC). DESIGN: Longitudinal population-based study. SETTING: Oral dysplasia clinics. PATIENTS: This study involved 118 patients with 118 severe dysplasia who were prospectively enrolled between 1996 and 2014, and the lesions were either completely removed surgically (treated) or actively followed (untreated). MEASUREMENTS: Demographics, habits, clinical information and outcome were compared between the treated and untreated groups. RESULTS: Of the 118 lesions, 77 were treated and 41 were not. The treated lesions showed significantly less progression when compared to the untreated: 5/77 (6%) treated lesions progressed into invasive SCC versus 12/41 (29%) untreated (P=0.004). The 5-year probability (confidence interval) of progression into SCC for the treated was 7.6 (1-14) as compared to 38.6 (16-55) for the untreated. Interestingly the clinical changes at the site of the disease also had strong predictive value for cancer progression. If the site showed no lesion after treatment or after incisional biopsy (40 cases), only 1 (3%) progressed into cancer. If the site showed ever disappearance of the lesion or marked decrease in the size of the lesion to ⩽10mm (29 cases), 4 (15%) progressed. If the site showed lesions with fluctuation in size or persistent in size or marked increase in size (25 cases), 18 (58%) progressed (P<0.001). CONCLUSION: Treatment significantly reduced cancer progression, and phenotypic changes at the site of the disease had significant predictive value for cancer progression.

Cyclin D1 overexpression is associated with poor prognosis in oropharyngeal cancer.

OBJECTIVES: To determine the biological characteristics of oropharyngeal squamous cell carcinoma (OpSCC) and related outcome. DESIGN: Retrospective study. METHODS: Patients (N=60) with primary OpSCC from 2000 to 2005 were retrospectively identified from Pathology database and the outcome was confirmed through chart review. Among these, 41 biopsy samples with enough tissues were retrieved to construct a tissue microarray for detection of the presence of high-risk human papillomavirus (HPV) using Chromogenic in situ hybridization (CISH) as well as the expression of p16 and cyclin D1 using immunohistochemistry. MAIN OUTCOME MEASURES: Disease-free survival. RESULTS: Among 60 patients, 39 (65%) patients had no recurrence or died without disease at the last follow-up (disease-free survival or Group 1), and 21 (35%) patients had persistent disease or died of disease (progression-free survival or Group 2). Although follow-up time was twice as long in group 1 (4.7 ± 2.2 vs. 2.0 ± 1.6 years; P < 0.0001), there was no difference between the 2 groups in age, gender, smoking/alcohol habits, TNM staging and treatment modalities. Among those 41 cases with available tumour tissues, there was no difference in HPV status and p16 expression between the 2 groups but a significant difference in cyclin D1 expression (P = 0.05). Using Kaplan-Meir survival analysis and log-rank test, cyclin D1 overexpression was highly associated with a poor prognosis when comparing time to outcome (P < 0.0001). CONCLUSION: Cyclin D1 overexpression is a potential prognostic marker of OpSCC.