Factores que influencian el retraso diagnóstico en el cáncer oral / Factors that influence the diagnostic delay of oral cancer

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Oral and oropharyngeal squamous cell carcinoma in young adults: A retrospective study in Granada University Hospital.

BACKGROUND: This study aims to evaluate and analyze the clinical features and outcomes of oral and oropharyngeal squamous cell carcinoma (SCC) in patients < 45-years old in our center. MATERIAL AND METHODS: A retrospective analysis was conducted using the records of patients diagnosed with oral and oropharyngeal SCC between 1998 and 2011 in the University Hospital of Granada (Spain). The analysis identified 33 patients with oral and oropharyngeal SCC with an age of <45 years. Moreover, during the years studied, a further 472 patients were diagnosed with oral and oropharyngeal SCC in our center. Thus, 100 SCC patients with an age of >45 years were randomly selected from the same database. A retrospective analysis was conducted to determine specific features including sites of occurrence, risk factors, sex distribution, socio-economic status, T stage at diagnosis, nodal involvement, degree of tumor differentiation, locoregional failure and overall survival at 5 years was. Further, the results of both groups were compared. RESULTS: The male-female ratio was 1.2:1 in the group of young adults and 2.03:1 in the group of patients with an age of >45 years. No significant differences were found in terms of site, nodal involvement, locoregional failure, and overall survival. However, there were statistically significant differences between the two groups in terms of features such as risk factors, socio-economic status, T stage at diagnosis, and degree of tumor differentiation. The overall 5-year survival rate was 62% for patients >45 years old, whilst for the group of young adults this rate was 48.4% (p= 0.17). CONCLUSIONS: The poor association between the common risk factors and oral and oropharyngeal cancers in young adults suggests that other pathogenic mechanisms should be investigated. For young patients, the data show evidence of poorer outcomes in terms of overall survival (p=0.17), and locoregional failure (p=0.23). Nevertheless, the literature shows that the results in this field are particularly inconsistent, and further research is therefore needed to provide more in-depth knowledge of the disease in this age group.

Pertinencia del uso de implantes dentales cortos en pacientes con atrofia ósea severa. Revisión de la literatura / Relevance of use of short dental implants in patients with severe bone atrophy. Literature review

El propósito de este artículo es determinar la pertinencia del uso de implantes cortos, definiéndolos como "aquellos cuya longitud es ≤8 mm" a través de la bibliografía existente. Hemos centrado la búsqueda en la comparación del uso de implantes de esta longitud, frente a otros tratamientos alternativos (injertos óseos, elevación de seno, transposición del nervio dentario, etc.) en pacientes con atrofia maxilar severa. Se dan respuesta a las siguientes cuestiones: ¿El uso de implantes dentales cortos es un tratamiento de resultados previsibles? ¿Los porcentajes de éxito a medio y largo plazo son equiparables a los de implantes con una longitud media estándar? ¿Pueden sustituir en determinadas situaciones clínicas a técnicas quirúrgicas avanzadas (injertos óseos, elevación de seno, distalización del nervio dentario) disminuyendo con ello la morbilidad, los tiempos en la rehabilitación y los costes para el paciente? ¿Se requiere de un protocolo clínico y prostético específico para garantizar el éxito en la rehabilitación? ¿En qué casos de atrofia maxilar se contraindica esta técnica a favor de otras como son los implantes cigomáticos o los injertos óseos? A través de una búsqueda cuasi-sistemática en metabuscadores, agencias de evidencias (revisiones sistemáticas) y bases de datos bibliográficos, exponemos la evolución de la evidencia al respecto, los últimos datos publicados y las conclusiones obtenidas (AU)

The purpose of this review is to determine the relevance of the use of short implants, defining them as "those whose length is ≤8 mm" according to the existing bibliography about it. We have centred the search on the use of implants of this length in comparison to alternative treatments (bony grafts, bone augmentation, dental nerve transposition, etc.) in patients with severe maxillary atrophy. It provides answers to the following questions: Is the use of short dental implants a treatment of foreseeable results? Are the percentages of success in the medium and long term comparable to those of implants with an average standard length? In certain clinical situations, can they be used as a substitute for other advanced surgical techniques (bony grafts, bone augmentation, distalization of the dental nerve), diminishing with it the morbidity, the rehabilitation periods and the cost for the patient? Is it required a specific prosthetic and clinical protocol to guarantee the success in the rehabilitation? In which cases of maxillary atrophy is this technique/treatment contraindicated in favour of other ones like zygomatic implants or bone grafts? Through an almost-systematic search in meta-search engine, agencies of evidence (systematic reviews) and bibliographical databases, we expose the evolution of the evidence on the matter, the most recent data published and the conclusions obtained (AU)

Suprabasal expression of Ki-67 antigen as a marker for the presence and severity of oral epithelial dysplasia.

BACKGROUND: Suprabasal expression of Ki-67 is assessed as a marker for oral dysplasia. The study involved non-neoplastic epithelium adjacent to 74 oral squamous cell carcinomas. METHODS: An immunohistochemical technique was carried out (peroxidase-antiperoxidase) with the monoclonal antibody MIB-1. Epithelial expression of Ki-67 was classified as being absent, basal, and suprabasal. The epithelium was normal in 19 cases, hyperplastic in 38 cases, and dysplastic in 37 cases. The dysplasia was slight in 20 cases, moderate in 12 cases, and severe in 5 cases. RESULTS: The results of the expression of Ki-67 were in normal epithelium, basal expression 9 cases, absent 10 cases; in hyperplastic epithelium, basal expression 18 cases, absent 20 cases; in dysplastic epithelium, basal and suprabasal expression (always jointly) 27 cases, absent 10 cases; all the severe and moderate dysplasia cases expressed suprabasal Ki-67. A significant association was observed between the presence (p <.0001) and severity (p <.007) of the dysplasia and the suprabasal expression of Ki-67.

Proliferating cell nuclear antigen (PCNA) as a marker of dysplasia in oral mucosa.

The development of head and neck cancer has been proposed to be a multistep process, with accumulation of genetic and phenotypic alterations resulting from carcinogen exposure. Proliferating cell nuclear antigen (PCNA), also called cyclin, is a 36-KD auxiliary protein of DNA polymerase-delta, that has been found to be a useful marker in immunocytochemical studies of cell proliferation because its expression correlates with the proliferative state of the cell. PCNA expression was analyzed in 10 samples of normal mucosa, 23 benign oral lesions (18 hyperplasia and 5 oral lichen plani), 10 oral lesions with epithelial dysplasia, and 10 dysplastic epithelia adjacent to tumors. Immunocytochemical stained sections were scored for the presence or absence of suprabasal PCNA positivity regardless of location. The results indicate that the PCNA expression in the suprabasal layers increased with the degree of epithelia dysplasia and in the samples of histological dysplastic epithelium adjacent to the tumors, while the percentage of suprabasal PCNA expression was insignificant in the samples of normal oral mucosa and benign oral lesions. The authors conclude that suprabasal PCNA expression could be a marker of dysplasia in oral mucosa, indicating a special proliferative cellular state in those lesions.

Some histopathological and clinical correlations in oral squamous cell carcinoma.

Oral squamous cell carcinoma (SCC) is an important health problem that causes high mortality and morbidity. Correlations between some clinical and histopathological parameters were studied in 37 oral SCC. Some interesting aspects in oral SCC arising from precancerous lesions were found such as smaller size and a lower TNM stage at the moment of diagnosis. Histological and clinical differences were also found between tumors invading deep tissues by little groups of dissociated malignant cells and those invading by big masses of malignant cells. The possible significance of the intensity of peritumoral eosinophilic infiltrate was also studied.