Are the demographics of recurrent oropharyngeal and oral cavity squamous cell carcinoma changing?

e18537 Background: In the current era of human papillomavirus (HPV)-related oropharyngeal cancer and decreasing alcohol and tobacco use, the demographic factors associated with recurrent head and neck cancer may be evolving. We evaluated clinical and demographic factors in a cohort of patients with recurrent and non-recurrent Oral Cavity (OC) and Oropharyngeal Squamous Cell Carcinoma (OPSCC) in order to evaluate which factors are associated with tumor recurrence and how these factors are modified by HPV status. Methods: From a cohort of 3201 patients diagnosed with OC and OPSCC at Kaiser Permanente Northern California between 1/1/2008 and 6/30/2019, 235 recurrent cases were identified. Clinical and demographic factors were extracted from electronic medical records. We calculated frequencies of demographic and clinical factors stratified by recurrence and HPV status, and reported p-values using the chi-square test for independence. Results: HPV-related cases were more likely to be male (84% vs. 64%), younger (80% ≤70 years old vs. 55%), have fewer comorbidities (61% with non-cancer Charlson index < 1 vs. 47%), and higher cancer stage (88% with a stage > 1 vs. 42%) than HPV-unrelated cases. Recurrent HPV-unrelated cases were more likely to be Asian (14% vs. 8%), and from higher income census tracts (75% from tracts with median household income > $60,000 vs. 66%) than recurrent HPV-related cases. Chi-square p-values of < 0.001. Recurrence and HPV status did not appear to be associated with prior smoking and alcohol abuse. Conclusions: Our cohort verifies that HPV-related OPSCC patients are more likely to be younger, male, and with lower Charlson scores, while recurrent HPV-unrelated OC and OPSCC may be more common among Asians and individuals from higher-income census tracts. This may have important implications for future clinical trial design and surveillance for recurrence. [Table: see text]

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Characteristics of the course of squamous cell carcinoma of the oral cavity depending on the HPV status.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e17579 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e17579-e17579

Author(s):

Pavel V. Svetitskiy ◽

Tatiana A. Zykova ◽

Viktoriya L. Volkova ◽

Irina V. Aedinova

Keyword(s):

Squamous Cell Carcinoma ◽

High Risk ◽

Oral Cavity ◽

Cell Carcinoma ◽

Squamous Cell ◽

Hpv Infection ◽

Lower Grade ◽

Tumor Tissues ◽

Hpv Status ◽

Formalin Fixed Paraffin Embedded

e17579 Background: HPV infection has a positive prognostic value in the treatment of patients with oropharyngeal squamous cell carcinoma. The purpose of the study was to evaluate the effect of HPV status on the course of oral cavity cancer. Methods: Formalin-fixed paraffin-embedded tumor tissues were studied in 34 patients with cancer of the floor of the mouth aged 47-85 years, 3 (8.8%) women and 31 (91.2%) men. All patients had histologically verified squamous cell carcinoma: stage (st) I in 1 (2.9%), II st - 8 (23.5%), III st - 12 (35.3%), IV st - 13 (38.3%); G1 in 15 (44.1%), G2 - 19 (55.9%). HPV DNAs were detected by Real-time PCR. Results: HPV DNAs were found in 12 (35.3%) samples of tumor tissues, including type 6 in 1 (2.9%), 11 in 3 (8.8%), 16 in 6 (17.6%), 35 in 1 (2.9%), 16+35 in 1 (2.9%). HPV+ tumors were more often in women (66.7% vs 32.3% in men), but high-risk HPV types were detected in men only - 8 (25.8%). Among patients aged 47-55 years, HPV+ tumor status was detected in 4 (33.3%), 56-65 years in 7 (53.8%), 66 years and older - in 1 (11.1%). In st I, no HPV+ tumors were observed; st II - 3 (37.5%) HPV+ tumors, low-risk in all; st III - 3 (25%) HPV+ patients, including high-risk in 2 (16.7%); st IV - 6 (46.2%) HPV+ samples, high-risk in all. G1 tumors: HPV+ in 7 (46.7%), HPV- in 8 (53.3%) patients; G2 tumors: HPV+ in 5 (26.3%), HPV- in 14 (73.7%) patients. Among patients with HPV+ tumors, metastases were observed in 5 (41.7%), no metastases - in 7 (58.3%); for patients with HPV- tumors, the values were 12 (54.5%) and 10 (45.5%) respectively. 4 (33.3%) patients with HPV+ tumors died, while 8 (66.7%) survived; for patients with HPV- tumors, the values were 12 (54.5%) and 10 (45.5%) respectively. Conclusions: The development of squamous cell carcinoma of the oral cavity was multidirectional and depended on the HPV status. HPV+ tumors, especially high-risk ones, were more often registered in stages III and IV. HPV+ tumors were more often lower-grade ones and less often metastasized; the mortality rate among patients with HPV+ tumors was lower than with HPV- ones.

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Differences in survival outcome between oropharyngeal and oral cavity squamous cell carcinoma in relation to HPV status

Journal of Oral Pathology and Medicine ◽

10.1111/jop.12535 ◽

2016 ◽

Vol 46 (8) ◽

pp. 574-582 ◽

Cited By ~ 7

Author(s):

Kenneth Lai ◽

Murray Killingsworth ◽

Slade Matthews ◽

Nicole Caixeiro ◽

Carlyn Evangelista ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Oral Cavity ◽

Cell Carcinoma ◽

Squamous Cell ◽

Survival Outcome ◽

Hpv Status

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Prognostic Role of Porphyromonas Gingivalis in Oral Cavity Squamous Cell Carcinoma Patients

10.21203/rs.3.rs-47862/v1 ◽

2020 ◽

Author(s):

Qingli Chen ◽

Zhe Shao ◽

Ke Liu ◽

Xiaocheng Zhou ◽

Lin Wang ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Oral Cavity ◽

Cell Carcinoma ◽

Porphyromonas Gingivalis ◽

Squamous Cell ◽

Systemic Disease ◽

Prognostic Indicator ◽

Chi Square ◽

Genotype I

Abstract Background: Oral microbial species play direct and/or indirect role in carcinogenesis of oral cavity squamous cell carcinoma (OSCC). Porphyromonas gingivalis (Pg) has been identified a correlation with OSCC. Fimbriae play a vital role for its attribution of initial attachment and adhesion of Pg. Six genotypes (types I-V, Ib) of fimA were identified based on sequence variations and the genotype was suggested a relationship to pathogenicity of Pg.Objective: To investigate the abundance of Pg in OSCC as well as the frequency of Pg fimA genotypes in OSCC patients.Methods: Ninety-five OSCC patients and thirty-nine gender- and age-matched non-OSCC subjects were investigated abundance of Pg in saliva. Presence of Pg was compared in OSCC tissue and para-cancerous tissue from patient as well. Clinical data were extracted and patients followed up for a mean period of 13 months. Presence of Pg and fimA genotypes were investigated in OSCC tissue and in saliva, then PCR products were sequencing and compared.Results: OSCC patients showed high abundance of Pg in saliva (Chi-square=14.531, P=0.001). OSCC tissue showed strong in situ expression of Pg by in situ hybridization compared with normal tissue adjacent to OSCC. Patients with overabundance of Pg in saliva are associated with systemic disease (Chi-square=10.328, P=0.029), longer disease-free time (Z=-2.988, P=0.003), and lower recurrence rate (Chi-square=5.670, P=0.017). The abundance of Pg was an independent favorable prognostic factor (HR: 0.124, 95%CI: 0.016 to 0.941). There was dominant distribution of Pg with genotype I+Ib (21.1%), II (31.6%) and IV (21.1%) in OSCC patients. The fimA genotypes detected in saliva were in accordance with those in OSCC tissue, and there was significantly correlation in amplified Pg fragments similarity between in saliva and in OSCC tissue. Conclusions: This study indicated that Pg might involve in the pathogenesis of OSCC, and Pg might consider as a potential prognostic indicator in OSCC. There was a dominant distribution of Pg with genotypes I, Ib, II and IV in OSCC patients. The presence of Pg in tumor might be saliva in provenance.

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HPV Status Improves Classification of Head and Neck Gray Zone Cancers

Journal of Dental Research ◽

10.1177/0022034519853771 ◽

2019 ◽

Vol 98 (8) ◽

pp. 879-887 ◽

Cited By ~ 1

Author(s):

J. Ren ◽

W. Xu ◽

J. Su ◽

X. Ren ◽

N. Bender ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Oral Cavity ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Classification Systems ◽

Gray Zone ◽

Hpv Status ◽

Icd Coding

In epidemiologic studies, patients with head and neck squamous cell carcinoma (HNSCC) are classified mainly by the International Classification of Diseases (ICD) codes. However, some patients are of an unclear subsite, the “gray zone” cases, which could reflect ICD coding error, absence of primary subsite, or extensive primary tumors that cross over multiple subsites of the oral cavity and oropharynx. Patients with gray zone squamous cell carcinomas were compared with patients with oral cavity squamous cell carcinoma (OSCC) or oropharyngeal squamous cell carcinoma (OPSCC) and stratified by human papillomavirus (HPV) status that was determined by p16 immunostaining or HPV serology. Comparisons consisted of clinicodemographic features and prognostic outcomes presented by Kaplan-Meier curves and Cox proportional hazards regression models, reported as hazard ratios. There were 158 consecutive patients with gray zone HNSCC diagnosed at the Princess Margaret Cancer Center between 2006 and 2017: 66 had subsite coding discrepancies against the clinician’s documentation (“discrepant” cases; e.g., the diagnosis by the clinician was OSCC, while the classification by ICD coding was OPSCC), while 92 were squamous cell carcinoma of unknown primary of the head and neck (SCCUPHN) after complete diagnostic workup. Comparators included 721 consecutive OSCC and 938 OPSCC adult cases. All HPV-positive cohorts (OPSCC, discrepant, and SCCUPHN) had similar clinicodemographic characteristics and better 3- and 5-y overall survival and disease-free survival than their HPV-negative counterparts. In contrast, HPV-negative discrepant cases had prognostic outcomes most similar to HPV-negative OPSCC cases, while HPV-negative SCCUPHN had survival outcomes most similar to those of patients with OSCC in this study. HPV-positive status can improve the classification of patients with unclear or discrepant oral/oropharyngeal subsite, an improvement over classification systems that are solely clinician defined or conducted through ICD coding. However, due to clinical practice, we could not make definitive reclassification for patients with HPV-negative gray zone HNSCC.

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Spindle Cell Carcinoma of the Tongue: Fallacies in Its Diagnosis

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol03-i02/14 ◽

2018 ◽

Vol 3 (02) ◽

Author(s):

Amrit Kaur Kaler, Shweta C, Smitha Chandra B.C, Rajeev Naik

Keyword(s):

Squamous Cell Carcinoma ◽

Oral Cavity ◽

Cell Carcinoma ◽

Cell Population ◽

Squamous Cell ◽

Spindle Cell ◽

Spindle Cell Carcinoma ◽

Biphasic Tumor ◽

Carcinoma Of The Tongue ◽

Ihc Markers

Spindle cell carcinoma is a rare aggressive biphasic tumor, composed of neoplastic proliferation of both epithelial (squamous) and spindle cell population. It constitutes about 1% of all oral cavity tumors 2a and is almost rare on the tongue; only few cases have been reported so far. This variant of squamous cell carcinoma, comprises major diagnostic problems due to its varied histomorphology and resemblance to sarcomatous lesion; hence diligent screening and IHC markers are mandatory for its diagnosis.

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PD-L1 and survival in oral cavity squamous cell carcinoma

Periodontology ◽

10.33925/1683-3759-2020-25-4-287-294 ◽

2020 ◽

Vol 25 (4) ◽

pp. 287-294

Author(s):

S. I. Kutukova ◽

N. P. Beliak ◽

G. A. Raskin ◽

M. S. Mukhina ◽

Yu. V. Ivaskova ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Oral Cavity ◽

Cell Carcinoma ◽

Tumor Cells ◽

Squamous Cell ◽

Immune Cells ◽

Negative Impact ◽

Progression Free Survival ◽

Negative Effect ◽

Effect Of Pd

Relevance. Prognostic value of PD-L1 expression in oral cavity squamous cell carcinoma (OCSCC) and its effect on survival is still controversial. It should be to determine the prognostic role of PD-L1 expression on tumor and immune cells of OCSCC and assess their effect on overall survival (OS) and progression-free survival (PFS).Materials and methods. A prospective study included 145 patients, first diagnosed with OCSCC. PD-L1 expression on tumor and immune cells, infiltrating tumor and its microenvironment, was assessed in all tumor samples by IHC, CPS was calculated. Cut-off values were determined by ROC analysis for identification of PD-L1 expression effect on OS and PFS.Results. Most patients with oral mucosa squamous cell carcinoma showed positive expression of PD-L1 on tumor (77.2%) and immune cells (92.4%). The median PD-L1 expression on tumor cells was 13.5% [1.0-40.0], the median PD-L1 expression on immune cells was 5.0% [1.0-11.0], and the median CPS – 18.0 [3.0-7.8]. Univariate and multivariate analyses revealed a significant negative effect of PD-L1 expression on immune cells ≤ 7% on OS (HR 0.66; 95% CI 0.45-0.93; p = 0.0498); PD-L1 expression in tumor cells ≤ 15% (HR 0.65; 95% CI 0.43-0.98; p = 0.0416) and CPS ≤ 21 (HR 0.62; 95% CI 0.44-0.92; p = 0.0183) for PFS. PD-L1 expression in tumor cells ≤ 6% (HR 0.71; 95% CI 0.47-1.08; p = 0.1096) and CPS ≤ 7 (RR 0.67; 95% CI 0.44-1.01; p = 0.0575) had a confident tendency to negative impact on OS.Conclusion. Positive PD-L1 expression in tumor and immune cells as well as CPS are effective additional factors in the prognosis of the disease course, OS and PFS in patients with OCSCC.

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The Length of Peri-Neural Spreading in Clinically Mandibular Invaded Oral Cavity Squamous Cell Carcinoma

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2020.05. ◽

2020 ◽

pp. 459-464

Keyword(s):

Squamous Cell Carcinoma ◽

Oral Cavity ◽

Cell Carcinoma ◽

Squamous Cell ◽

Lymphovascular Invasion ◽

Perineural Invasion ◽

Inferior Alveolar Nerve ◽

Surgical Margin ◽

Neural Invasion ◽

Resected Margin

Background: The objective of surgical management of oral squamous cell carcinoma (OSCC) is adequate resection with a clear margin. However, there is still a debate as to the optimal length for a mandibular resected margin. Objective: To examine the length of peri-neural spreading in T4 mandibular invaded oral cavity squamous cell carcinoma. Materials and Methods: Twenty-eight T4 pathological OSCC specimens that involved mandible and serial slices were studied and the length of tumor spreading along the inferior alveolar nerve (IAN) was determined. Tumor characteristics, risk factors, and survival were analyzed. Results: The incidence of peri-neural invasion was 11.11%, and IAN invasion was found in 14.29% of the tumor-invaded mandibular marrow. The length of tumor spreading along IAN was 3 to 12 mm. Poor prognostic factors of T4 OSCC were it being located on the tongue (HR 14.16), was pathological N2-3 (HR 31.05), and had high-risk features such as peri-neural invasion, lymphovascular invasion, and extra-nodal extension. Conclusion: A mandibular resected margin of at least 18 mm is recommended as a clear surgical margin in cases of T4 mandibular invasion OSCC. Keywords: Oral cancer, Perineural invasion, Inferior alveolar nerve, Squamous cell carcinoma, Mandibulectomy

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