Clinicopathological risk factors for local recurrence in oral squamous cell carcinoma

doi:10.1016/j.ijom.2012.07.011

International Journal of Oral and Maxillofacial Surgery

Volume 41, Issue 10, October 2012, Pages 1195-1200

https://doi.org/10.1016/j.ijom.2012.07.011 Get rights and content

Abstract

Local recurrence of oral squamous cell carcinoma (OSCC) after primary surgery has been considered to be a poor prognostic entity in terms of survival rate. The purpose of this study is to evaluate the incidence of local recurrence and to identify significant risk factors for the local recurrence in OSCC. The authors retrospectively reviewed records for 187 patients who underwent radical surgery for OSCC. The local recurrence rate was 16.0% (30/187 patients) in this study. The survival rate of patients with local recurrence was 33.3%, which was significantly lower than that (94.3%) of patients without local recurrence. Pattern of invasion (POI), neoadjuvant chemotherapy (NAC), and the status of the surgical margin were identified as factors influencing local recurrence. In particular, NAC and the status of the surgical margin were independent risk factors by multivariate analysis. The deep margin was resected at a close site in many NAC-treated patients, suggesting that NAC may lead to local recurrence and poor outcomes. No efficacy of NAC was observed, suggesting that the standard treatment of oral cancers is surgery alone.

Section snippets

Patients and methods

The authors retrospectively reviewed records for 187 patients who underwent radical surgery for OSCC between January 2001 and December 2010. The study cohort included patients with histologically confirmed diagnoses of OSCC and a minimum follow-up of 12 months. All study patients underwent extensive pretreatment evaluations, including blood chemistry, complete blood cell count, chest X-ray, computed tomography (CT) and/or magnetic resonance imaging (MRI) of the head and neck area,

Results

Patient characteristics are summarized in Table 1. The male to female ratio was 1.2 with 102 male subjects. The mean age at diagnosis was 67.3 years (range 28–95 years). The most common primary site was the tongue (73/187 patients, 39.0%); 23.5% of patients had lower gingival cancer and 19.3% had upper gingival cancer.

The local recurrence rate was 16.0% (30/187 patients) during the follow-up period. The mean follow-up period was 36.7 months for the whole series (range 10–125 months). The mean

Discussion

The clinical course of a patient with OSCC is determined by specific primary tumour factors, host characteristics, and, naturally the type of treatment modality.⁴ Locoregional recurrence in patients with OSCC remains a problem and can affect their survival.2, 6, 7 In particular, local recurrence is a high potential risk factor for survival. Some studies demonstrated that demographic variables such as site, TNM stage, and simultaneous disorder, and pathological variables such as depth of

Funding

None.

Competing interests

None declared.

Ethical approval

Not required.

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Long noncoding RNAs (lncRNAs) regulate cancer cell senescence in many cancers. However, their specific involvement in head and neck squamous cell carcinoma (HNSCC) remains unclear. We are looking for an ingenious prognostic signature that utilizes senescence-related lncRNAs (SRlncRNAs) to predict prognosis and provide insights into the immune landscape in HNSCC.
HNSCC clinical and Cellular senescence genes information were collected from The Cancer Genome Atlas and Human Aging Genomic Resources. Then we performed Cox and Lasso regression to locate SRlncRNAs related to the prognosis of HNSCC and built a predictive signature. Further, prognosis assessment, potential mechanisms, and immune status were assessed by Kaplan–Meier analysis, Gene Set Enrichment Analysis (GSEA), and CIBERSORT, respectively.
A prognosis prediction model based on sixteen SRlncRNAs was identified and internally validated. Then, patients with high-risk scores suffered an unfavorable overall survival (All p < 0.05). The risk score, age, and stage were independent prognostic parameters (all p < 0.001). Our model has good predictive ability (The AUC (area under the curves) 1-year = 0.707, AUC3-year = 0.748 and AUC5-year = 0.779). Subsequently, GESA revealed SRlncRNAs regulated immune responses. Patients in the high-risk group had higher tumor mutation burden and Tumor Immune Dysfunction and Exclusion but lower levels of 37 immune checkpoint genes, immune scores, and immune cells like CD8 + T cells, follicular helper T cells, and regulatory T cells.
A prognostic model based on SRlncRNAs is the potential target for improving immunotherapy outcomes for HNSCC.
The copy number variation of GSTM1 as a promising prognostic factor of oral squamous cell carcinoma
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Citation Excerpt :
About the CNV of GSTT1, the progression-free survival curves showed no difference in the pattern of the relapse's occurrence (Figure 5), and no copies of GSTT1 were related to the OSCC relapses risk, as summarized in Table 6. The occurrence of OSCC relapses are generally related to high classifications of tumor-node-metastasis stage, histologic grade, and the depth of tumor invasion6 that are probably a consequence of the late tumor detection, in which two-thirds of patients with OSCC are diagnosed with the advanced stage of the disease.32 Although these clinic pathologic characteristics have been applied to determine the prognosis of the patients with OSCC, studies have reported controversial results about their association with the risk of the occurrence of relapses.6,8
The aim of this study was to investigate whether the copy number variation (CNV) of GSTM1 and GSTT1 is related to the occurrence of oral squamous cell carcinoma (OSCC) relapses, along the overall and progression-free survival of patients.
A total of 234 OSCC patients were recruited from the Heliópolis hospital and they were distributed among 4 groups according to the occurrence of OSCC relapses. Fisher exact test, odds ratio (OR), and 95% CI were determined to investigate the chances of OSCC progression. The overall and progression-free survival were analyzed by the Kaplan-Meier and Cox regression methods.
The CNV of GSTM1 analysis showed that one copy of the gene was associated with reduced chances of OSCC recurrences (OR 0.45; 95% CI 0.25-0.81) and decreased the risk of tumor progression (HR 0.50; 95% CI 0.33-0.75). Furthermore, one copy of GSTM1 was related to a better overall survival rate (HR 0.63; 95% CI 0.0.44-0.91). Regarding the CNV of GSTT1, no copies were associated with the chances of OSCC relapses, the overall survival, or the progression-free survival.
The CNV of GSTM1 may be applied to predict OSCC relapses and aid the treatment management, which might improve the survival rates of patients.
Crosstalk between oral squamous cell carcinoma cells and cancer-associated fibroblasts via the TGF-β/SOX9 axis in cancer progression
2021, Translational Oncology
Cancer-associated fibroblasts (CAFs) have important roles in promoting cancer development and progression. We previously reported that high expression of sex-determining region Y (SRY)-box9 (SOX9) in oral squamous cell carcinoma (OSCC) cells was positively correlated with poor prognosis. This study developed three-dimensional (3D) in vitro models co-cultured with OSCC cells and CAFs to examine CAF-mediated cancer migration and invasion in vitro and in vivo. Moreover, we performed an immunohistochemical analysis of alpha-smooth muscle actin and SOX9 expression in surgical specimens from 65 OSCC patients. The results indicated that CAFs promote cancer migration and invasion in migration assays and 3D in vitro models. The invading OSCC cells exhibited significant SOX9 expression and changes in the expression of epithelial–mesenchymal transition (EMT) markers, suggesting that SOX9 promotes EMT. TGF-β1 signalling inhibition reduced SOX9 expression and cancer invasion in vitro and in vivo, indicating that TGF-β1-mediated invasion is dependent on SOX9. In surgical specimens, the presence of CAFs was correlated with SOX9 expression in the invasive cancer nests and had a significant impact on regional recurrence. These findings demonstrate that CAFs promote cancer migration and invasion via the TGF-β/SOX9 axis.
Oral Lichen Planus-Associated Oral Cavity Squamous Cell Carcinoma Is Associated With Improved Survival and Increased Risk of Recurrence
2020, Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
Patients with OLP-OCSCC had the greatest stage-for-stage survival benefit with stage IV disease. The present study also found a greater rate of locoregional recurrence or SPT in patients with OLP-OCSCC than that previously reported for OCSCC,37-45 with more than one half of the patients developing at least 1 locoregional recurrence or SPT, one quarter of which occurred within the first year after the initial diagnosis of OCSCC. The study findings of the high recurrence and SPT rate in OCSCC are consistent with those previously reported.
We investigated the overall survival (OS), disease-specific survival (DSS), and disease-free survival among patients with oral lichen planus-associated oral cavity squamous cell carcinoma (OLP-OCSCC). The secondary objective was to assess the annual risk of tumor recurrence or second primary tumor (SPT).
A comparative retrospective study was performed of patients with OLP-OCSCC presenting between June 2007 and December 2018 to the Department of Oral and Maxillofacial Surgery, Michigan Medicine (Ann Arbor, MI) and patients with OCSCC in the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database (1973 to 2015).
A total of 87 patients with OLP-OCSCC met the inclusion criteria, and 55,165 patients with OCSCC from the SEER database were included. The proportion of women was greater in the OLP group than in the SEER group (56.3 vs 38.0%; P < .001). In the OLP group, 47.1% had no smoking history and 43.7% had no alcohol history. Most patients in the OLP group had presented with stage I disease (46.0%) compared with 31.7% in the SEER group (P = .004). Overall, the OS and DSS were significantly greater in the OLP group than in the SEER group at all points from 1 to 5 years (P ≤ .01). In the OLP group, 46 patients (52.9%) had at least 1 recurrence or SPT. At 10 years, the predicted mean number of recurrences was 1.93 per patient (95% confidence interval, 1.56 to 2.39).
OLP-OCSCC frequently affects women, nonsmokers, and nondrinkers and presents with localized disease at a high frequency. Patients with OLP-OCSCC have increased OS and DSS and a greater risk of tumor recurrence or SPT compared with OCSCC in the general population. Lifelong, frequent surveillance is recommended for patients with OLP-OCSCC owing to the risk of late recurrence. Future studies are needed to understand the pathophysiology of OLP-OCSCC.
Time to recurrence and patient survival in recurrent oral squamous cell carcinoma
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Citation Excerpt :
In multivariate analysis, the timing of recurrence (p < 0.001), the margin status of the primary tumour (p = 0.023), the presence of extracapsular spread in the primary tumour (p = 0.003) and the performance of a salvage treatment (p < 0.001) were shown to be independent risk factors for overall survival in patients with recurrent disease (Table 3). Tumour recurrence is associated with a dramatic worsening of the patient’s prognosis and therefore remains one of the major problems in managing OSCC [2,3,12,16]. The mortality rate in our population was 41.5%, while other authors even describe mortality rates in patients with recurrent disease from 79.2% to 92% [5,7,10].
Tumour relapse remains one of the major problems in managing oral squamous cell carcinoma (OSCC) with mortality rates of up to 92%. Early recurrences have a worse prognosis than late relapses. However, few has been written about the influence of clinicopathological parameters on the timing of recurrence and the patient survival.
Retrospective chart review of 159 patients with an OSCC recurrent disease. Exclusion criteria were neoadjuvant chemoradiotherapy, follow-up <6 weeks, perioperative death, second primaries and inadequate information on clinicopathological parameters. Statistical analysis was performed using univariate and multivariate analysis.
A significant correlation was found in the χ2-analysis between the timing of recurrence and the margin status (p = 0.020), lymph node ratio (p = 0.030) and grading (p = 0.003) of the primary tumour. In the multivariate survival analysis, the timing of recurrence (p < 0.001), margin status of the primary tumour (p = 0.023), presence of extracapsular spread in the primary tumour (p = 0.003) and performance of a salvage treatment (p < 0.001) were shown to be independent risk factors for overall survival.
For patients with a recurrent OSCC, the time to recurrence, margin status, extracapsular spread and the performance of a salvage treatment are independent prognostic factors for overall survival. Furthermore, a significant association exists between the moment of recurrence and the lymph node ratio, the margin status and grading of the primary tumour. This knowledge can allow for the development of individualised surveillance programs and like this, an earlier diagnosis and better second treatment chance in the case of a recurrence.
Identification of a Prognostic Model Based on Cuproptosis and Ferroptosis-Related Genes in Patients with Head and Neck Squamous Cell Carcinoma
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Clinical PaperHead and Neck OncologyClinicopathological risk factors for local recurrence in oral squamous cell carcinoma

Abstract

Section snippets

Patients and methods

Results

Discussion

Funding

Competing interests

Ethical approval

J Oral Maxillofac Surg

J Oral Maxillofac Surg

Oral Oncol

Oral Oncol

Int J Radiat Oncol Biol Phys

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

J Oral Maxillofac Surg

Oral Oncol

Lancet

Int J Oral Maxillofac Surg

Am J Surg

Oral Oncol

Oral Oncol

Int J Oral Maxillofac Surg

J Oral Maxillofac Surg

Clinical Paper
Head and Neck Oncology
Clinicopathological risk factors for local recurrence in oral squamous cell carcinoma