Impact on patients with oral squamous cell carcinoma in different anatomical subsites: a single-center study in Taiwan.

The incidence of oral cavity squamous cell carcinoma (OSCC) is particularly high in South Asia. According to the National Comprehensive Cancer Network, OSCC can arise in several subsites. We investigated survival rates and the clinical and pathological characteristics of OSCC in different anatomical subsites in the Taiwanese population. We retrospectively analyzed data for 3010 patients with OSCC treated at the Changhua Christian Hospital. Subsequently, we compared clinical and pathological features of OSCC in different subsites. Pathological T4 stage OSCCs occurred in the alveolar ridge and retromolar trigone in 56.4% and 43.7% of cases, respectively. More than 25% of patients with tongue OSCC and 23.4% of those with retromolar OSCC had lymph node metastasis. The prognosis was worst for hard palate OSCC (hazard ratio 1.848; p < 0.001) and alveolar ridge OSCC (hazard ratio 1.220; p = 0.017). Retromolar OSCC recurred most often and tongue OSCC second most often. The risk for cancer-related mortality was highest for hard palate OSCC, followed by alveolar ridge and retromolar OSCC. We found distinct differences in survival among the different subsites of OSCC. Our findings may also help prompt future investigations of OSCC in different subsites in Taiwanese patients.

Prevalence and incidence of oral cancer in low- and middle-income countries: A scoping review.

INTRODUCTION: Oral cancer is common cancer in many low- and middle-income countries (LMICs) with a low five-year survival rate. It is among the four most common types of cancer in South East Asia region. In South-Central Asia, lip and oral cavity cancer is the second most common cancer according to the specific cancer types. METHODS: This scoping review intended to investigate published studies on the current prevalence and incidence of oral cancer in LMICs. The review was conducted applying the search words "Oral Cancer" and "Mouth neoplasm" as the Medical Subject Heading (MeSH) major topic and "Epidemiology" and ("prevalence" OR "incidence") as the MeSH subheading; the search was supplemented by cross-references. Included studies met the following criteria: original studies, reporting of prevalence or incidence rates, population-based studies, studies in English language and studies involving humans. RESULTS: The sample sizes ranged from 486 to 101,761 with 213,572 persons included. Buccal mucosa is one of the most common sites of oral cancer, associated with the widespread exposure to chewing tobacco. The incidence is likely to rise in the region where gutkha, pan masala, pan-tobacco and various other forms of chewing tobacco are popular. CONCLUSION: This review contributes to useful information on prevalence and incidence estimates of oral cancer in LMICs.

Squamous Cell Carcinoma of the Soft Palate in the United States: A Population-Based Study.

Objectives To describe the incidence and determinants of survival of patients with squamous cell carcinoma of the soft palate (SCCSP) using the Surveillance, Epidemiology, and End Results (SEER) database. Study Design Retrospective, population-based cohort study of patients. Setting SEER cancer registry. Subjects and Methods Patients from the SEER cancer registry from 1973 to 2015 were used to analyze demographics and survival of SCCSP. Results A total of 4366 cases were identified. The average overall survival (OS) and disease-specific survival (DSS) were 68.7 months and 161.3 months, respectively. Multivariate analysis revealed that male sex, stage, and treatment (hazard ratio [HR] = 0.690, P = .019; HR = 1.73, P < .001; HR = 0.64, P < .001, respectively) were independent determinants of better or worse DSS. Age, stage, and treatment (HR = 1.02, P < .001; HR = 1.49, P < .001; HR = 0.66, P < .001; HR = 0.48, P < .001, respectively) were independent determinants of better or worse OS. For stages I, II, and III, radiation alone and surgery alone have nearly equivalent OS. Patients with stage IV disease who underwent both surgery and radiation had a significantly higher median OS at 50.0 months. Conclusion Radiation alone and surgery alone both have nearly equivalent OS benefit for stages I to III, while surgery and radiation provide the most survival benefit for stage IV disease. The large discrepancy between OS and DSS can be due to significant comorbidities. Future studies should aim to address the determinants of quality-of-life variables that help direct treatment decisions and might indirectly affect survival.

Tumours of the salivary glands in northeastern China: a retrospective study of 2508 patients.

Little information has been published in English about the epidemiology of tumours of the salivary glands in northeastern China. From August 2004 to March 2014, 2508 cases of primary epithelial salivary gland tumours were diagnosed in the Department of Oral and Maxillofacial Surgery, the Affiliated Stomatology Hospital of China Medical University. Tumours were analysed according to their histological type and site, and the age and sex of the patients. Ages ranged from 5 to 98 years, with a slight propensity in favour of men. The peak incidence was in the sixth decade for both sexes. The mean (SD) ages were 48 (16) years when the tumour was benign and 51 (15) years when it was malignant. The parotid gland and palate were the sites most commonly affected. There were 1934 (77.1%) benign and 574 (22.9%) malignant tumours, with the most common histological types being pleomorphic adenomas and mucoepidermoid carcinomas. A lesion that arises from the floor of the mouth (92.8%) or the tongue (86.2%) is more likely to be malignant than those from other minor salivary glands.

Minor salivary gland neoplasms.

OBJECTIVE: This study aimed to investigate the clinical presentation, histopathologic and epidemiological aspects, as well as the treatment modalities and outcomes of patients with minor salivary gland tumors (MSGTs). SUBJECTS AND METHODS: A series of 23 patients with MSGTs were reviewed retrospectively. RESULTS: This study included 11 (48%) benign and 12 (52%) malignant tumors of minor salivary glands. Minor salivary gland tumors were more common in men (70%) than in women (30%). The mean age was 31.3 years for benign tumors and 46.3 years for malignant tumors. Pleomorphic adenoma was the most common benign tumor, followed by myoepithelioma. Mucoepidermoid carcinoma and adenoid cystic carcinoma were the most common malignant tumors. The most common symptom was a painless mass of the palate. Surgical treatment was performed in all patients. Adjuvant radiotherapy was used in 3 malignant tumors. Twenty-three patients were followed-up for a median of 5 years. Two patients with malignant tumors underwent a second surgery for postoperative local recurrence. They were successfully treated with the second surgery. CONCLUSIONS: Minor salivary gland tumors are relatively uncommon neoplasms of the head and neck region. There is limited literature on MSGTs. This study provides a versatile approach for MSGTs from demographic data and clinical presentations to treatment modalities and treatment outcomes.

Primary nodular lymphocyte predominant Hodgkin lymphoma of the palate: a rare incidence which was also associated with progressive transformation of germinal centres of cervical lymph node.

Primary manifestation of nodular lymphocyte predominant Hodgkin lymphoma in oral cavity is very rare. We are describing such a case which was associated with progressive transformation of germinal centres in a cervical lymph node.

Incidence of oral cavity and pharyngeal cancers by anatomical sites in population-based registries in Puerto Rico and the United States of America.

OBJECTIVE: Puerto Rico's (PR) epidemiological data on each oral cavity and pharynx cancer (OCPC) site is yet largely unexplored. Our aim was to compare OCPC incidence in PR, by anatomical site, with that of non-Hispanic whites (NHW), non-Hispanic blacks (NHB), and Hispanic (USH) individuals in the USA. METHODS: Data from the Surveillance Epidemiology and End Results program and the PR Central Cancer Registry were collected and analyzed. Age-standardized rates, percent changes, and standardized rate ratios were estimated with 95% confidence intervals. RESULTS: Although declining incidence rates were observed for most anatomical sites in most racial/ethnic groups and in both sexes, the incidence of oropharynx cancers slightly increased for cancers in the oropharynx among PR women, both in the base of tongue and soft palate/other oropharynx (p>0.05). The incidence of soft palate/other oropharynx cancers in PR men was about 2.8 times higher than in USH men (p<0.05) and about 1.4 times higher than in NHW men but 21% lower than in NHB men (p>0.05). Significant interactions terms formed with racial/ethnic group and age were shown in various sites. The largest differences between sexes were consistently noted in PR. CONCLUSION: Further research in PR should assess the effect of the HPV infection, as well as of other risk factors, in OCPC incidence by anatomical site in younger populations. These data could explain more precisely the reasons for the differences observed in this study, particularly among sexes in PR.

Tobacco smoking, alcohol drinking and risk of oral cavity cancer by subsite: results of a French population-based case-control study, the ICARE study.

The objective was to examine the role of tobacco smoking and alcohol drinking in the incidence of oral cavity cancer by subsite in France, a high-incidence area. We analysed detailed data on lifelong tobacco smoking and alcohol drinking from 772 oral cavity cancer cases and 3555 controls included in a population-based case-control study, the ICARE study. Tobacco smoking increased the risk of oral cavity cancer even for the smaller quantities and durations, whereas alcohol drinking increased this risk only in heavy drinkers who were also ever smokers. The combined effect of smoking and drinking was greater than multiplicative. The floor of the mouth was the subsite that was the most affected by the harmful effects of tobacco and alcohol, whereas the gums were less susceptible. The risk associated with tobacco and alcohol consumption did not differ between intraoral cavity and subsites usually included in the oropharynx (soft palate and base of the tongue). Population-attributable risks for oral cavity cancer were 78.6% for tobacco smoking, 7.3% for alcohol drinking and 80.7% for tobacco and/or alcohol consumption. These results indicate that regular oral check-ups should be targeted at smokers and heavy drinkers, and that prevention efforts should be focused on smoking cessation.

Racial disparity in oral and pharyngeal cancer in Florida in 1991-2008: mixed trends in stage of diagnosis.

OBJECTIVES: To explore changes in distribution of stage at diagnosis among individuals with oral and pharyngeal cancers over the past two decades and whether the changes differ by race. METHODS: We obtained 1991-2008 cancer incidence data for nine anatomic sites of the oral and pharyngeal structure from the Florida Cancer Data System. These cancers were grouped into oral squamous cell carcinoma (SCC), pharyngeal SCC, and other head and neck cancers. Annual percent change was calculated for each group to characterize trends in age-adjusted cancer incidence over time by race and stage at diagnosis. RESULTS: During 1991-2008, the overall age-adjusted oral SCC incidence was decreasing for both races, with a greater decline observed among Blacks. There was a large drop in incidence of regional-stage diagnoses among Blacks. For pharyngeal SCC, the age-adjusted incidence of localized- and regional-stage diagnoses was increasing for Whites during 1991-2008, with the largest increase in the incidence of regional-stage diagnoses. The percentage of localized-stage diagnoses was increasing for both races for oral SCC. A slight increase in percentage of localized-stage diagnoses was observed for Blacks for pharyngeal SCC, whereas no obvious change was observed among Whites. CONCLUSIONS: Blacks continued to have lower percentages of localized-stage diagnoses than Whites for nearly all sites, but an increasing percentage of localized-stage diagnoses was observed for oral SCC among Blacks. For pharyngeal SCC, the increase in incidence among Whites was accompanied by an increasing percentage of late-stage diagnoses. Coordinated public health approaches with a special emphasis on screening underserved populations are needed.

Role of cigarette filter on the risk of oral cancer: a case-control study in a Chinese population.

OBJECTIVE: To determine the role of cigarette filter on the incidence risk of oral squamous cell cancer among male smokers in a Chinese population. SUBJECTS AND METHODS: A multicentric hospital-based case-control study was applied. Three hundred and nineteen male cases and 428 male controls matching for age ( ± 3 years) were identified from January 2008 to December 2010. Detailed smoking histories were obtained by interviews. Logistic regression model was used to compare the influence of filter and non-filter cigarettes on oral cancer risk. RESULTS: The adjusted odd ratios (ORs) for oral cancer were 1.30 (95% CI 1.15, 1.48) of filter cigarette smokers, 2.06 (95% CI 1.17, 3.62) of non-filter cigarette smokers, and 1.73 (95% CI 1.33, 2.25) of mixed smokers, as compared with non-smokers. When classified current smokers according to smoking pack year, the ORs of mixed smokers were 2.27 (95% CI 1.06, 4.85) in <20 pack year, 0.81 (95% CI 0.57, 1.14) in 20-39 pack year, and 0.86 (95% CI 0.57, 1.29) in ≥ 40 pack year, as compared to filter cigarette smokers. CONCLUSIONS: The protective effect against oral cancer of cigarette filter was limited, restricted to smokers of small amount of smoking accumulation. For most smokers, the difference was non-significant between filter and non-filter cigarettes on the risk of developing oral cancer.

Geographic differences and time trends of intraoral cancer incidence and mortality in Bavaria, Germany.

OBJECTIVE: To examine possible geographic differences and time trends of intraoral cancer (IOC) incidence and mortality in Bavaria between 2002 and 2008. METHODS: Incidence data for IOC (ICD-10 codes, C01-C06) were obtained from the population-based cancer registry Bavaria. Age-specific and age-standardised IOC incidence and mortality rates in Bavaria and its regions were calculated separately by sex and year of diagnosis. RESULTS: We found an excess incidence of 34% and 25% among men and women in Upper Franconia compared to Bavaria. Incidence and mortality related to IOC in Bavaria are comparable to those found in other European cancer registries. IOC mortality appears to decrease over time in both sexes, whereas IOC incidence appears to decrease only in men. CONCLUSIONS: The observed geographic differences with respect to IOC incidence and mortality in Bavaria may possibly be explained in part by socioeconomic differences.

T1-T2 squamous cell carcinoma of the uvula: a little big enemy.

OBJECTIVE: No specific epidemiology data are available for carcinoma of the uvula. This study aims to analyze the epidemiological characteristics and treatment outcomes of carcinoma of the uvula at the authors' institution. STUDY DESIGN: Case series with chart review. SETTING: Service of ENT-Head and Neck Surgery, University Hospital Complex of Santiago de Compostela (CHUS), Spain. SUBJECTS AND METHODS: Retrospective epidemiological study of 21 male patients, mean age 57.52 years, diagnosed with squamous cell carcinoma of the uvula in the CHUS between January 1990 and June 2009. RESULTS: Most patients presented with odynophagia and exophytic lesions microscopically consistent with moderately differentiated squamous cell carcinoma. Despite the size of the lesions (T1 and T2), more than half of the patients had lymph node metastases at diagnosis. More than 90.0% of patients with lesions larger than 1 cm presented with lymph node metastases. Although more than 70.0% of patients underwent a neck dissection in the first year after diagnosis, only 25.0% were free of metastatic disease. Recurrences occurred at a mean of 14 months from baseline in more than 50.0% of cases. Of the patients, 52.4% died, with a median survival of 38.15 months after diagnosis. The overall 5-year survival was 39.0%. According to tumor size, 5-year survival was 53.0% for T1 and 27.0% for T2. CONCLUSION: According to the data, clinical features of carcinoma of the uvula correspond with aggressive tumors, with rapid onset and a major negative impact regardless of tumor size at diagnosis. Early stage patients benefit significantly from surgical treatments with neck dissections.

Salivary gland tumours: 25 years of experience from a single institution in Croatia.

INTRODUCTION: The aim of this study was to determine the types, frequency, distribution, and demographic characteristics of salivary gland tumours in a large representative sample. PATIENTS AND METHODS: We retrospectively analysed the medical records of 779 patients with tumours of the salivary glands surgically treated from 1985 to 2009 at a single institution. RESULTS: There were 500 benign and 279 malignant tumours. The average age of patients with benign tumours was 50 years and of malignant salivary gland tumours 56 years. No differences in age and incidence of tumours existed between males and females. The majority of the tumours occurred in the parotid gland (509), followed by the minor salivary glands (212), the submandibular gland (51) and lastly, the sublingual gland (7). Minor salivary gland tumours occurred most frequently on the palate, the pleomorphic adenoma being the most frequent benign tumour type and the adenoid cystic carcinoma being the commonest malignant tumour. Tumours of the sublingual gland were rare, but all were malignant. Malignant tumours were more common in the minor salivary glands and the submandibular gland. CONCLUSION: This large study of salivary gland tumours in Croatia could improve our understanding of the significant differences in the global distribution of salivary gland tumours which have been reported.

Oral melanotic macule and primary oral malignant melanoma: epidemiology, location involved, and clinical implications.

BACKGROUND: Oral malignant melanoma must be differentiated from melanotic macule. STUDY DESIGN: Retrospective review of 2 series of oral melanotic macule (n = 52) and oral melanoma (n = 130) were conducted to investigate the epidemiology and location involved and assess their differences. RESULTS: The mean age of oral melanotic macule patients was 47.3 years, with female:male ratio 2.1 and the lower lip being the predominant location. The mean age of oral melanoma patients was 53.8 years, with no observed sex predilection and the main locations being palate and gingiva. Differences between the 2 cohorts in age (P = .006), gender (P = .014), and lesion site (P < .001) were noted. In this review, 1 case of oral melanotic macule was found to subsequently develop into melanoma. CONCLUSIONS: Oral melanotic macule may possess malignant potential. Biopsy is recommended to differentiate oral melanoma from melanotic macule for male patients >60 years old with suspected melanotic macule lesion located on the palate.

Clinico-histopathologic types of maxillofacial malignancies with emphasis on sarcomas: a 10-year review.

BACKGROUND: Sarcomas are malignant neoplasms that occur anywhere in the human body. Though their occurrence in the head and neck region is rare vis-a-vis other malignancies, their presence is of tremendous concern due to their often grave prognosis. OBJECTIVE: To determine the pattern of occurrence, histopathologic types of maxillofacial sarcomas and their proportion to other malignant neoplasms of this region based on archival material accumulated over 10 years (2000-2009). DESIGN: A combined retrospective and prospective cross-sectional study. SETTING: The University of Nairobi Dental Hospital (UNDH). SUBJECTS: All cases with a diagnosis of sarcoma registered between 2000-2009 were evaluated. RESULTS: Of the 528 malignancies recorded over the ten-year period, 427 (80.9%) were of epithelial origin while 101 (19.1%) were sarcomas. Patients with epithelial malignancies were older (54.16 +/- 15.94 years) than patients with sarcomas (31.73 +/- 16.78) with the differences having been statistically significant. Osteosarcoma was the most commonly occurring sarcoma (29.7%), followed by Kaposi's sarcoma (KS) (28.7%), fibrosarcoma (FBS) (18.8%), and rhabdomyosarcoma (RMS) (9.9%). Sarcomas peaked in the third decade with 70% occurring below the age of 40 years. The maxilla and the mandible were the most afflicted sites in the maxillofacial region accounting for 52%. The patients on average presented to medical personel about nine months after noticing the lesion with the most frequent complaint having been swelling. CONCLUSION: The present study confirms the relative rarity of maxillofacial sarcomas. It also provides data on the histopathologic types and demographic characteristics of maxillofacial sarcomas in a select Kenyan population. This information is a contribution to the comprehensive documentation of sarcomas that occur globally and is useful in the provision of baseline data upon which future prospective analytical protocols may arise.

Trends in the epidemiology of oral squamous cell carcinoma in Western UP: an institutional study.

OBJECTIVE: The purpose of the study was to identify trends in incidence rates of oral squamous cell carcinoma (OSCC) at specific anatomic sites or within specific age or sex groups in the Western Uttar Pradesh population. MATERIALS AND METHODS: The study covers the period from January 2004 through April 2009. OSCC cases were retrospectively analysed for site, age, gender and habits and the findings were formulated to chart the trends in Western U.P. RESULTS: The study revealed a male to female ratio of 2.2:1 with the largest number of OSCCs developing in the fourth and fifth decades of life. Overall, the most common site was the buccal mucosa (63.75%), followed by retromolar area (15%), floor of the mouth (11.25%), lateral border of the tongue (3.75%), labial mucosa (3.75%), and palate (2.5%). Smokeless tobacco habit was more prevalent than smoking tobacco in both men as well as women. Karl - Pearson's correlation coefficient was calculated to find the degree of association between the two variables i.e. between gender to buccal mucosa and gender to smokeless and smoking tobacco habits, which were found to be positively correlated with respect to the age. CONCLUSION: Oral cancer is an important cause of morbidity and mortality worldwide with an incidence rate that varies widely by geographic location. Even within one geographic location, the incidence varies among groups categorized by age, sex, site or habit.

Oral leukoplakia in China: a review.

BACKGROUND: Most prevalence studies on oral leukoplakia (OL) in China have been published in the Chinese language. The present review on the literature in Chinese aimed at making the data available to colleagues who are not familiar with the Chinese language. METHODS: The overall rate and 95% confidence interval of OL were calculated using Excel 2003. RESULTS: Overall prevalence of OL was 9.18% (95%CI = 9.06-9.30%). Gender ratio of prevalence was 8.03:1 (males/females). Prevalence was high in age groups over 40 years with the highest in the group aged 60-69 years (21.04%, 95%CI = 19.95-22.13%). The buccal mucosa was most commonly affected (47.08%, 95%CI = 46.52-47.64%), followed by lip (39.09%), palate (9.85%), gingiva (1.80%), and tongue (1.46%). The prevalence in smokers was 23.43% and in non-smokers 1.93%. Among three variants of smoking, the traditional Hanyan pipe smoking carried the highest risk for the development of OL followed by cigarette and Shuiyan water pipe smoking. The rate of alcohol drinkers with OL was 54.50% and 22.21% in individuals without OL. No case of oral cancer was found in six surveys. CONCLUSIONS: The present data on the prevalence of OL in China are comparable to those in other parts of the world. Some traditional smoking habits, however, are particular to certain regions of China.

Malignant minor salivary gland tumors: a retrospective study of 27 cases.

PURPOSE: Malignant tumors of the intra-oral minor salivary glands are uncommon. The aim of this study was to give information concerning the clinical features of these tumors, the distribution of location, treatment opportunities, and outcome. METHODS: Twenty-seven patients with malignant salivary gland tumors that were treated between January 1999 and December 2008 were evaluated retrospectively. RESULTS: Of the 27 minor salivary gland carcinomas, 48.1% were adenoid cystic carcinomas (ACC), 29.7% mucoepidermoid carcinomas (MEC), 22.2% adenocarcinomas (ADCA). The most common first symptom was a painless swelling in 60% of the cases, with the second most common symptom being ulcers (28%). Four recurrences and two metastases were found. No recurrence was observed in ADCA. All four patients experiencing a recurrence developed it in the first 3 years after treatment. CONCLUSION: Wide excision with a clinical margin of 1 cm and in large tumors, positive surgical margins or perineural infiltration and postoperative radiotherapy (RT) can be recommended; but in order to give exact information concerning the possible benefit from postoperative RT, it needs large prospective multicenter studies. Long-term follow-up controls and in particularly longer than 5 years in ACC including yearly chest X-rays should be offered to these patients because of late metastasis and recurrences.

Salivary gland neoplasms in oral and maxillofacial regions: a 23-year retrospective study of 6982 cases in an eastern Chinese population.

There is little information in the English-language literature about the epidemiology of salivary gland neoplasms in the eastern Chinese population. A large retrospective study (6982 primary salivary tumors during 23 years) was carried out to investigate the clinicopathological features (tumor location, patient sex and age) of these tumors in this population. 3593 tumors were in males and 3389 in females. Pleomorphic adenoma (69%) was the most common tumor and 20% were located in minor glands. 92% of Warthin's tumors occurred in males. Malignant tumors were predominantly adenoid cystic carcinoma (30%) and mucoepidermoid carcinoma (30%). Incidences of lymphoepithelial carcinomas (5%) and polymorphous low-grade adenocarcinoma (1%) of malignant tumors were identified. 28% of tumors originated from minor glands. Most findings were similar to those in the literature, with some variations. The salivary tumors slightly predominated in males. Relatively higher incidences of minor gland tumors and specifically of pleomorphic adenoma in minor glands were noted. Adenoid cystic carcinoma and mucoepidermoid carcinoma constituted the most common malignancies. There was a high incidence of lymphoepithelial carcinomas but a low incidence of polymorphous low-grade adenocarcinoma. The historical significant male predominance of Warthin's tumor was confirmed.