Association of DOK3 and infiltrated tumor-associated macrophages with risk for the prognosis of Porphyromonas gingivalis-infected oral cancer: a 12-year data analysis of 200 patients from a tertiary teaching hospital, Urumqi, China.

BACKGROUND: While there is an understanding of the association between the expression of Porphyromonas gingivalis (P. gingivalis) and prognosis of oral squamous cell carcinoma (OSCC), significance specially to address the relevance between different immunohistochemical intensities of P. gingivalis and tumor-associated macrophages (TAMs) in OSCC tissue and related clinicopathologic characteristics has not been well investigated. The present study aimed to investigate the pathological features related to M2-TAM in P. gingivalis-infected OSCC and ascertain its clinical relevance with patients' prognosis. METHODS: A prospective cohort study was designed to comparatively analyze 200 patients from June 2008 to June 2020. Bioinformatics analyses were implemented to identify DOK3 as a key molecule and to appraise immunocyte infiltration using Gene Expression Omnibus and The Cancer Genome Atlas databases. Immunohistochemical evaluation was performed to analyze the association between the expression levels of P. gingivalis, DOK3, and M2-TAM and clinicopathological variables using Fisher's exact test or Pearson's chi-square test. Cox analysis was used to calculate hazard ratios (HR) with corresponding 95% confidence interval (CI) for various clinicopathological features. The Kaplan-Meier approach and log-rank test were used to plot the survival curves. RESULTS: The expression level of P. gingivalis was positively associated with DOK3 and M2-TAMs expression level (P < 0.001). Parameters, including body mass index, clinical stage, recurrence, tumor differentiation, and P. gingivalis, DOK3, and M2-TAM immunoexpression levels, affected the prognosis of patients with OSCC (all P < 0.05). In addition, P. gingivalis (HR = 1.674, 95%CI 1.216-4.142, P = 0.012), DOK3 (HR = 1.881, 95%CI 1.433-3.457, P = 0.042), and M2-TAM (HR = 1.649, 95%CI 0.824-3.082, P = 0.034) were significantly associated with the 10-year cumulative survival rate. CONCLUSIONS: Elevated expression of P. gingivalis and DOK3 indicates M2-TAM infiltration and unfavorable prognosis of OSCC, and could be considered as three novel independent risk factors for predicting the prognosis of OSCC.

The association between referral by specialists in oral diagnosis on survival rates of patients with oral cancer: A retrospective cohort study.

BACKGROUND: To assess the influence of diagnosis and referral provided by specialists in oral diagnosis on disease-free survival and overall survival of patients with oral cancer. METHODS: A cohort of 282 patients with oral cancer treated at a regional cancer hospital from 1998 to 2016 was analyzed retrospectively. The referral register of the patients was analyzed and assigned to two groups: (1) those referred by oral diagnosis specialists (n = 129), or (2) those referred by nonspecialized professionals (n = 153). The cancer treatment evolution was assessed from the patients' records, and the outcome was registered concerning cancer recurrence and death. Sociodemographic and clinicopathological variables were explored as predictors of disease-free survival and overall survival. RESULTS: Group 1 exhibited lower T stages and a reduced incidence of regional and distant metastases. Surgery was performed in 75.2% of cases in Group 1, while in Group 2, the rate was 60.8%. Advanced T stages and regional metastases reduced the feasibility of surgery. Higher TNM stages and tumor recurrence were associated with decreased disease-free survival, while surgical intervention was a protective factor. Higher TNM stage had a negative impact on the overall survival. CONCLUSION: Specialized oral diagnosis did not directly impact disease-free survival and overall survival and did not influence the indication of surgery in oral cancer; however, it was associated with the diagnosis of early tumors and better prognosis.

Epidemiology and management of oral cavity squamous cell carcinoma in Ireland.

INTRODUCTION: The epidemiology and management of oral cavity cancer have changed considerably in recent decades. This study examines epidemiological and management trends in oral cavity squamous cell carcinoma (OCSCC). METHODS: A retrospective cohort study of data from the National Cancer Registry of Ireland between 1994 and 2014. RESULTS: A total of 2725 patients were identified. The most common subsites were the tongue (34 %, n = 1025), lip (19 %, n = 575), floor of mouth (FOM) (18 %, n = 550), and retromolar trigone (RMT) (6 %, n = 189). The incidence of OCSCC remained largely unchanged (3.14 cases/100000/year) during the study period. 5-year disease-specific survival (DSS) was 58.6 % overall, varying between subsites (lip 85 %, RMT 62.9 %, tongue 54.7 %, and FOM 47.3 %). DSS improved over the study period (p = 0.03), in particular for tongue primaries (p = 0.007). Primary surgery significantly improved DSS versus radiotherapy (HR 0.28, p < 0.0001). Survival of T4 disease managed surgically was superior to that of T1 disease managed with radiotherapy. In node positive patients, chemotherapy improved overall survival (HR 0.8 p = 0.038) but not DSS (HR 0.87 p = 0.215). CONCLUSION: Primary surgery remains the standard of care in the management of OCSCC. Prognosis has improved in line with an increase in the use of primary surgery in the same time frame, though the incidence remains unchanged.

Spatial-temporal analysis of hospitalizations with death caused by oral cancer in Brazil and its correlation with the expansion of healthcare coverage.

BACKGROUND: Oral cancer (OC) is a growing public health problem worldwide. In Brazil, the National Oral Health Policy, implemented in 2004, expanded access to oral health services and prioritized OC care. However, it is not known whether this expansion resulted in a reduction in hospital admissions with death. This study aimed to analyze the proportion of hospital admissions who progressed to death due to OC in Brazil from 2007 to 2019 and its correlation with the coverage of health services. MATERIAL AND METHODS: This study is an ecological, longitudinal, and analytical study of hospital admissions with death due to OC recorded in the Brazilian Hospital Information System. The following analyses were performed: descriptive, spatial (choropleth maps and Moran index), and negative binomial regression, with a hierarchical approach, estimating crude and adjusted regression coefficients (ß) and respective 95% confidence intervals (95% CI) (alpha=5%). RESULTS: In 2019, Moran's index (I) of spatial autocorrelation showed a negative association between hospital admissions with death and dentist surgeon/inhabitant rate (I=-0.176), physician/inhabitant rate (I=-0.157), family health strategy (FHS) coverage (I=-0.080), oral health team (OHT) coverage (I= -0.129), dental specialty centers (DSC)/inhabitant rate (I= -0.200), and oncology bed/inhabitant rate (I= -0.101). In the adjusted regression analysis, the proportion of hospitalizations with deaths caused by OC was higher in Brazilian states with a lower medical ̸inhabitant ratio (ß= -0.014; p=0.040), a lower dentists/inhabitant ratio (ß= -0.720; p=0.045), a lower number of DSC (ß= -0.004; p<0.000), a lower amount paid per hospitalization (ß= -10.350; p<0.001), and a lower number of biopsies (ß= -0.00008; p=0.010). The proportion of hospitalizations that progressed to death showed a positive association with the number of days of hospitalization (ß= 0.00002; p=0.002). CONCLUSIONS: Increased health care coverage has decreased serious hospital admissions with deaths caused by OC in Brazil.

Central neck lymph node metastasis in oral squamous cell carcinoma at the floor of mouth.

BACKGROUND: Our goal was to analyze the incidence of level VI metastasis in previously untreated oral squamous cell carcinoma (SCC) patients and their clinicopathological and prognostic characteristics. METHODS: Oral SCC patients with level VI metastasis were retrospectively enrolled, and their demographic and pathologic features as well as their survival data were descriptively analyzed. RESULTS: A total of 13 cases from 1875 patients were included, all patients had SCC at the floor of mouth (SCCFOM). Eight (61.5%) patients had a pT4 tumor, and all patients had a pathological N3 neck with multiple positive lymph nodes. Adverse pathologic features were present in 100% of the patients. The size of the metastatic foci in level VI ranged from 2.6 cm to 4.5 cm with a mean value of 3.2 cm, and 5 patients showed a soft tissue deposit with no lymph node component. Recurrence occurred in all patients, and 11 patients died of uncontrolled cancer within 5 years after surgery. CONCLUSION: Level VI metastasis in primary oral SCCFOM is rare, and its prognosis is poor.

Downregulation of CCL22 and mutated NOTCH1 in tongue and mouth floor squamous cell carcinoma results in decreased Th2 cell recruitment and expression, predicting poor clinical outcome.

OBJECTIVE: Tongue and mouth floor squamous cell carcinoma (T/MF SCC) exhibits a high rate of local recurrence and cervical lymph node metastasis. The effect of the tumor microenvironment on T/MF SCC remains unclear. MATERIALS AND METHODS: Transcriptome and somatic mutation data of patients with T/MF SCC were obtained from HNSC projects of the Cancer Genome Atlas. Immune infiltration quantification in early- (clinical stage I-II) and advanced-stage (clinical stage III-IV) T/MF SCC was performed using single sample Gene Set Enrichment Analysis and MCPcounter. Differentially expressed gene data were filtered, and their function was assessed through Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses. Kaplan-Meier survival curve analysis and Cox regression model were conducted to evaluate the survival of patients with the CCL22 signature. Maftools was used to present the overview of somatic mutations. RESULTS: In T/MF SCC, T helper (Th)2 cell counts were significantly increased in patients with early-stage disease compared to those with advanced-stage disease. Expression of the Th2 cell-related chemokine, CCL22, was downregulated in patients with advanced-stage T/MF SCC. Univariate and multivariate Cox analyses revealed that CCL22 was a good prognostic factor in T/MF SCC. A nomogram based on the expression of CCL22 was constructed to serve as a prognostic indicator for T/MF SCC. NOTCH1 mutations were found at a higher rate in patients with advanced-stage T/MF SCC than in those with early-stage T/MF SCC, resulting in the inhibition of the activation of the NOTCH1-Th2 cell differentiation pathway. The expression levels of CCL22, GATA-3, and IL4 were higher in patients with early-stage T/MF SCC than in those with advanced-stage T/MF SCC. CONCLUSION: In T/MF SCC, high expression of CCL22 may promote the recruitment of Th2 cells and help predict a better survival. Mutations in NOTCH1 inhibit the differentiation of Th2 cells, facilitating tumor progression through a decrease in Th2 cell recruitment and differentiation.

Tracking the dropout patients of neoadjuvant chemotherapy with locally advanced oral cavity cancer.

BACKGROUND: Patients with locally advanced oral cavity cancer sometimes stopped treatment after neoadjuvant chemotherapy. There are no guidelines of the management for these patients. Before designing clinical trials, we conducted this study to investigate their characteristics, reasons of dropout, and the follow-up information. METHODS: Medical records were consecutively reviewed of patients with locally advanced oral cavity cancer who underwent neoadjuvant chemotherapy from Jan 2017 to Dec 2019.Variables were compared between patients stopped treating after chemotherapy and completed treatments by student t-test and Chi-square test. Logistic regression model was used to calculate the odd rations of potential predictors of dropout. The dropout patients were followed up for reasons and results of their decision. RESULTS: A total of 171 patients were included with 23 not undergoing surgery after chemotherapy. The odd ratios of age over 65 and single marital status were 3.11 (95%CI: 1.1, 8.7) and 4.935 (95%CI: 1.5, 16.1), respectively, for the dropout. The median survival of patients without surgery was 7.4 months. Believing that chemotherapy would be effective and being afraid of the consequence of surgery were the main reasons of refusing surgery. CONCLUSIONS: The prognosis was poor of these dropout patients. Symptom relief and fear of surgery were the reasons of dropout. Age and marital status affected their decision. Clinical trials are needed to be designed for these patients.

Identification of Salivary Biomarkers for Oral Cancer Detection with Untargeted and Targeted Quantitative Proteomics Approaches.

Oral cavity squamous cell carcinoma (OSCC) is one of the most common cancers worldwide. In Taiwan, OSCC is the fifth leading cause of cancer-related mortality and leads to 2800 deaths per year. The poor outcome of OSCC patients is principally ascribed to the fact that this disease is often advanced at the time of diagnosis, suggesting that early detection of OSCC is urgently needed. Analysis of cancer-related body fluids is one promising approach to identify biomarker candidates of cancers. To identify OSCC biomarkers, salivary proteomes of OSCC patients, individuals with oral potentially malignant disorders (OPMDs), and healthy volunteers were comparatively profiled with isobaric tags for relative and absolute quantitation (iTRAQ)-based mass spectrometry (MS). The salivary levels of 67 and 18 proteins in the OSCC group are elevated and decreased compared with that in the noncancerous group (OPMD and healthy groups), respectively. The candidate biomarkers were further selected using the multiple reaction monitoring (MRM)-MS and validated with the immunoassays. More importantly, the higher salivary level of three proteins, complement factor H (CFH), fibrinogen alpha chain (FGA), and alpha-1-antitrypsin (SERPINA1) was correlated with advanced stages of OSCC. Our results indicate that analysis of salivary proteome is a feasible strategy for biomarker discovery, and the three proteins are potential salivary markers for OSCC diagnosis.

Oral tegafur-uracil as a metronomic therapy in stage IVa and IVb cancer of the oral cavity.

PURPOSE: This study aimed to evaluate the impact of accumulated oral tegafur-uracil (UFUR) as maintenance chemotherapy on overall survival (OS) and disease-free survival (DFS) rates after definitive treatment for non-distant metastatic stage IV cancer of the oral cavity. MATERIALS AND METHODS: This retrospective, hospital center-based study analyzed data of patients diagnosed with stage IVa and IVb cancer of the oral cavity who underwent surgical resection and concurrent chemoradiotherapy (CCRT) obtained from a database between October 2008 and December 2014. RESULTS: Forty-two patients were treated with CCRT (non-UFUR group); the remaining 51 patients received the same regimen, followed by additional oral UFUR (UFUR group). For all study patients, the 3-year DFS rates were 53.05% and 35.41% in the UFUR and non-UFUR groups, respectively (p = 0.011), while the 3-year OS rates were 74.96% and 48.47%, respectively (p = 0.001). CONCLUSIONS: Adding UFUR to CCRT significantly improved the DFS and OS rates in patients with non-distant metastatic stage IV cancer of the oral cavity.

Clinicopathological analysis of oral diffuse large B-cell lymphoma, NOS: A systematic review.

BACKGROUND: Diffuse large B-cell lymphoma, NOS (DLBCL NOS) is the commonest extranodal non-Hodgkin lymphoma diagnosed in the oral and maxillofacial region. However, few studies are currently available and its prognostic determinants remain undefined. PURPOSE: To analyse the available data on oral DLBCL NOS and to describe its clinicopathological features, identifying potential prognostic factors. METHODS: An electronic systematic search was performed using multiple databases with a specific search strategy in April 2018. All reports describing DLBCL NOS involving the oral cavity and jaw bones with sufficient clinicopathological information were assessed. RESULTS: Sixty-three publications were included in the study, comprising 122 cases. Oral DLBCL NOS was found predominantly in elderly males (61.5%), and most often presented as an asymptomatic swelling of the gingiva. Patients commonly were HIV-negative (36.1%), with few reports describing EBV-positive cases (four cases/3.3%). Only eight cases presented B symptoms and most cases were classified as stage I or II (48.4%). CHOP therapy was the main treatment option (24.5%) and the overall 5-year survival rate achieved 83%. Males and advanced Ann Arbor stage patients presented significantly lower survival rates in the univariate analysis, but no significance was found in the multivariate model. CONCLUSION: Oral DLBCL NOS is an aggressive malignancy, but with a high survival rate.

Intraoperative cytological examination of bone medullary. A useful technique to predict the extension of bone invasion in segmental mandibulectomy.

AIM: The main of the present report is to evaluate the utility of intraoperative cytological analysis of medullary bone to predict the extension of bone infiltration in segmental mandibulectomy. MATERIALS AND METHOD: Between the years 2016 and 2018, a total of 17 previously untreated patients with squamous cell carcinoma of the oral cavity underwent a segmental mandibular resection and intraoperative cytological analysis of the bone medullary at Virgen de las Nieves University Hospital (HUVN). The results of the intraoperative cytological analysis were compared with the result of the postoperative histopathological examination and sensitivity, specificity, positive predictive value, and negative predictive value of the test were calculated. RESULTS: Cytological analysis was positive in three patients and the bone resection was consequently extended. All the extensions of these bone margins were clean following the postoperative histological examination. However, two other patients previously classified as clean with intraoperative cytological analysis of bone medullary presented infiltration of bone margins postoperatively. The protocol demonstrated a high negative predictive value (85,7%). The positive predictive value, sensitivity, and specificity were 33,3%, 33,3%, and 85,7% respectively. CONCLUSION: Intraoperative cytological analysis of bone medullary could represent an easy, fast, reliable and inexpensive method to reduce the rate of r1 surgeries attributable to the infiltration of the bone margin. This may have a positive impact on overall survival without increasing the duration and the iatrogenicity of surgery.

Reconstruction of Anterior Mandible and Mouth Floor Using the Myofascial Iliac Crest Free Flap After Tumor Resection.

The current study introduces a novel approach of anterior mandible and mouth floor reconstruction with the myofascial iliac crest free flap. A series of 4 patients who presented between May 2015 and July 2017 had benefited from this technique. The myofascial component of this flap was designed to be attached to the iliac crest, and the flap was obtained after identifying the neurovascular pedicle. We transferred the iliac crest, with an outward-oriented placement, to the mandibular defect as the base of the alveolar process. We found that the iliac crest can provide sufficient bone height and an aesthetic shape for the reconstruction of the anterior mandible. More important, we also observed that the myofascial component on the flap surface completely replaced the oral mucosa in as early as 1 month after the operation. Moreover, the proper soft tissue volume can be achieved using this approach for better functional reconstruction of the oral mucosa. No obvious scar contracture of the myofascial component was observed during the follow-up period. The myofascial iliac crest free flap could provide a suitable reconstruction method for combined oral mucosa-mandible defects.

Serum Levels of Interleukin-6 and Titers of Antibodies Against Porphyromonas gingivalis Could Be Potential Biomarkers for the Diagnosis of Oral Squamous Cell Carcinoma.

It has been suggested that Porphyromonas gingivalis (P. gingivalis), a keystone pathogen in chronic periodontitis, is associated with a variety of cancers, including oral cancer. Recently, studies have shown the effects of persistent exposure to P. gingivalis on the promotion of tumorigenic properties of oral epithelial cells, suggesting that chronic P. gingivalis infection is a potential risk factor for oral cancer. On the other hand, Fusobacterium nucleatum (F. nucleatum), one of the major periodontal pathogens, has emerged as an important factor in the colon cancer progression. Here, we investigated the diagnostic potential of serum immunoglobulin G antibody against periodontal pathogens, P. gingivalis and F. nucleatum, and serum IL-6 for oral squamous cell carcinoma (OSCC). An enzyme-linked immunosorbent assay (ELISA) was used to determine and compare the serum levels of interleukin 6 (IL-6), F. nucleatum IgG, and P. gingivalis IgG in 62 OSCC patients with 46 healthy controls. The serum levels of P. gingivalis IgG and IL-6 were higher in OSCC patients than in non-OSCC controls, and the difference was statistically significant. In addition, a high serum level of IL-6 was associated with a worse prognosis in OSCC patients. Thus, P. gingivalis IgG and IL-6 could be utilized as potential serum biomarkers for the diagnosis of OSCC, and the serum level of IL-6 contributes to improved prognostic performance.

The histologic risk model is a useful and inexpensive tool to assess risk of recurrence and death in stage I or II squamous cell carcinoma of tongue and floor of mouth.

Surgery is the mainstay of treatment for low-stage (stage I/II, ie, T1N0/T2N0) squamous cell carcinoma of oral cavity. However, a significant percentage of low-stage squamous cell carcinoma of oral cavity will develop local recurrence and disease-related mortality. In this study, we stratified 64 patients with low-stage of oral tongue and floor of mouth patients into high-, intermediate- and low-risk categories based on existing histologic risk model. The classification of these risk categories was based on presence or absence of perineural invasion and evaluation of tumor-host junction for worst pattern of invasion and lymphocytic host response. We correlated risk category and other variables with recurrence and death. In a univariate model, high-risk category tumors had a significantly higher rate of recurrence and death due to recurrence compared with low/intermediate-risk categories (P=0.000 and P=0.047, respectively). Controlling for margin status and T-stage, high-risk category had a 12.4 odds ratio of later recurrence when compared with low/intermediate-risk categories, with a P-value of 0.001. In conclusion, we found low-stage oral cavity squamous cell carcinoma patients with high-risk category have a significantly higher risk for recurrence when compared with patients in the low- or intermediate-risk category, even when controlling for margin status and T-stage. These patients may be suitable candidates for adjuvant treatment to decrease morbidity and mortality associated with a recurrence. Our results indicate that the histologic risk model is a useful and simple tool to assess risk of recurrence in stage I or II squamous cell carcinoma of oral cavity.

A decreased peritumoral CD1a+ cell number predicts a worse prognosis in oral squamous cell carcinoma.

AIMS: Dendritic cells (DCs) are known to play a central role in the regulation of both innate and adaptive immunological responses, including antitumour immunity. The aim of this study was to evaluate the prognostic impact of intratumoral and peritumoral DCs in oral squamous cell carcinoma (OSCC) affecting the tongue and floor of the mouth. METHODS AND RESULTS: Immunohistochemistry for CD1a and CD83 was performed in 53 patients with OSCC in the tongue and floor of the mouth. The markers were evaluated by automated examination in intratumoral and peritumoral compartments, and the results were expressed as density of cells/mm2 . Correlations between these data and clinicopathological and survival outcomes were investigated. Depletion of peritumoral CD1a+ cells was associated with lymph node metastasis (P = 0.05), whereas depletion of peritumoral CD83+ cells was correlated with smoking history (P = 0.04), lymph node metastasis (P = 0.015), and extracapsular spread of lymph nodes (P = 0.018). Peritumoral CD1a+ was correlated with recurrence (P = 0.007) and overall survival (P = 0.03). The results of the survival analysis with the Cox proportional hazard model showed that depletion of peritumoral CD1a+ cells is an independent factor associated with overall survival and disease-free survival. CONCLUSION: Our results suggest that depletion of peritumoral CD1a+ cells is a strong independent prognostic factor, predicting a higher recurrence rates and worse survival outcomes.

Clinicopathological analysis of oral plasmablastic lymphoma: A systematic review.

BACKGROUND: Plasmablastic lymphoma (PBL) is a high-grade lymphoma that often affects the oral cavity of HIV-positive patients; however, its prognostic determinants remain unknown. PURPOSE: To integrate the available data on oral PBL to determine its clinicopathological features and to identify potential prognostic factors. METHODS: An electronic systematic review was performed using multiple databases with a specific search strategy in February 2018. Inclusion criteria comprised cases diagnosed as PBL affecting the oral cavity and gnathic bones with sufficient data to confirm the diagnoses. RESULTS: A total of 70 publications were included, representing 153 cases. Oral PBL predominantly affected HIV-positive males (76.4%). EBV was observed in 63.4% of the cases. The gingiva was the most involved site and the lesion usually presented as an asymptomatic swelling. Most cases were classified as stage I (21.6%), and chemotherapy alone was applied in 28.8% of the cases. There was a significant association between HIV and EBV infections, and cases affecting HIV-negative patients were more common in older individuals. Cumulative survival of the patients achieved 42.4% and 33.5% after 2 and 5 years, respectively. Although there were no statistically significant clinicopathological parameters in the univariate analysis, the multivariate Cox regression model demonstrated that EBV-positive status, presence of B-symptoms, and chemotherapy alone were independent prognostic determinants of a poor prognosis. CONCLUSION: Oral PBL is an aggressive neoplasm with low survival rates, which is influenced by the presence of EBV, presence of B-symptoms, and with the use of chemotherapy only.

Does Different Mandibulectomy (Marginal vs Segmental) Affect the Prognosis in Patients With Oral Squamous Cell Carcinoma?

PURPOSE: It is unclear whether different mandibular surgical methods affect the prognosis of patients with oral squamous cell carcinoma (OSCC). Accordingly, the authors retrospectively compared the prognosis of patients who underwent marginal mandibulectomy (MG) or segmental mandibulectomy (SG) for OSCC and aimed to determine the factors influencing prognosis. MATERIALS AND METHODS: The authors conducted a retrospective cohort study of 82 patients with OSCC who underwent mandibulectomy at their hospital from January 2001 through January 2015. All patients had a biopsy-confirmed diagnosis of OSCC adjacent to the lower mandible. The local recurrence rate and survival rate after these 2 treatment modalities were analyzed using Kaplan-Meier survival analysis. At univariate and multivariate analyses, the Cox regression model was used to screen risk factors for recurrence, including pathologic grade, pT stage, mandibular involvement, lymph node metastasis, and method of mandibulectomy. Statistical significance was considered when P values were less than .05. RESULTS: Of the 82 patients, 39 underwent MG and 43 underwent SG. According to statistical analysis, age, gender, pathologic grade, tumor stage, mandibular involvement, and lymph node metastasis were similar between the 2 groups. The 3- and 5-year local recurrence rates were not significantly different between the 2 groups (P > .05). The 3- and 5-year survival rates were not significantly different between the 2 groups (P > .05). Poorly differentiated pathologic type was the only prognostic factor for OSCC at multivariate Cox regression analysis (P = .001). CONCLUSION: The results of this study suggest that MG is safe for some evaluated patients with OSCC. Of the prognostic factors studied, MG was not associated with worse prognosis; however, poorly differentiated OSCC affected the prognosis for oral carcinoma.

Role of Non-Albicans Candida and Candida Albicans in Oral Squamous Cell Cancer Patients.

PURPOSE: This study examined the prevalence of Candida species in the saliva of oral squamous cell carcinoma patients and its effect on the mortality rate. MATERIALS AND METHODS: One hundred patients with oral cavity squamous cell carcinoma undergoing protocol treatment at Helsinki University Hospital were recruited into the study from March 2011 through 2014. For comparison, 75 age-matched controls with no current or previously treated oral cancer were recruited. Paraffin-stimulated whole saliva samples were collected and cultivated on CHROMagar Candida medium (CHROMagar, Paris, France) to establish possible Candida growth. The API ID 32C yeast identification kit (bioMérieux, Lyon, France) and Bichro-Dubli Fumouze latex agglutination test (Fumouze Diagnostics, Levallois-Perret, France) were used for further identification of different Candida species. Patients' medical records were studied for information on their health habits and general health status, as well as tumor-related data. The patients' status regarding being alive and cancer free was checked at a follow-up point in December 2017. Descriptive statistics and cross tabulation were carried out, and the P value was set at .05. RESULTS: Candida species were detected in 74% of the oral cancer patients' samples, with C. albicans being the most common species (84%). Other species identified were C. dubliniensis (8%), C. tropicalis (4%), C. glabrata (3%), C. parapsilosis (3%), C. sake (3%), C. krusei (1%), and C. guilliermondii (1%). After the follow-up period, 63% of the patients were alive and 86% of them were cancer free. Harboring Candida species in the saliva was not associated with any increase in the mortality rate. CONCLUSIONS: C. albicans was common in the oral cavity of the oral squamous cell carcinoma patients. However, in this patient population, we did not observe a statistically significant effect of the yeast on the mortality rate.

Outcome of compartment resection of locally advanced oral cancers extending to infratemporal fossa: a tertiary rural hospital experience.

Locally advanced oral cancers extending to infratemporal fossa (ITF) are a challenge to head and neck surgeons. These tumors are classified as T4b whenever the masticator space (MS), pterygoid muscles (PM), and pterygoid plates (PP) are involved according to AJCC classification. Until recently, these tumors were considered inoperable and treated only with palliative intent. However, a few studies in the last decade showed that many of these tumors could be resected with a reasonably favorable prognosis by compartment resection of ITF, particularly when the tumor was below sigmoid notch of mandible. A few studies attempted to downstage these tumors by neo-adjuvant chemotherapy before attempting resection. Oral Squamous cell carcinoma has a high prevalence in South India. Majority of these patients are females addicted to tobacco quid chewing and present with locally advanced disease. In this retrospective analysis, we evaluated the outcome of treatment of oral squamous cell carcinoma extending to ITF and staged T4b in 52 patients. All patients underwent Composite resection including compartment resection of ITF followed by adjuvant treatment. 20 patients had received neo-adjuvant chemotherapy. Pectoralis major myocutaneous flap was the mainstay of reconstruction. After mean follow-up of 2 years, 31 patients are alive and disease free. 14 patients had local recurrence in ITF and 2 patients had recurred in cervical nodes. 8 patients died due to disease and 6 are on palliative care. Neo-adjuvant chemotherapy did not benefit the outcome. Close margins of resection, extra nodal spread from lymph nodes and supra notch and involvement of posterior part of ITF were factors which predisposed to recurrence.

Spatial analysis of the death associated factors due oral cancer in Brazil: an ecological study.

BACKGROUND: Oral cancer (OC) is among the ten most common cancers and the seventh most frequent cause of death worldwide. It has been reported that these incidence rates are higher in developed country and these mortality rates are higher in less developed areas. So, the objective of the present study was to analyze the spatial joint distribution and to explore possible associations of the epidemiological aspects with mortality rates due to OC in the Brazil. METHODS: An exploratory ecological study investigated the global spatial autocorrelation of epidemiological aspects with mortality rates due to OC from the Brazilian Federative Units (FUs) (n = 27) in the period 2005-2014, using the "global" and "local" Moran statistic method and a multiple spatial regression, having as variables of exposure the habits and lifestyle, sociodemographic indicators, the consumption of pesticides, the presence of comorbidities, the use of health services and food consumption; and, as a variable response, mortality rates due to OC. The software used was Stata 11.0, SPSS 18.0 and GeoDa 0.95-i. RESULTS: The spatial distribution of OC mortality rates to age-standard was not random and showed high spatial autocorrelation and predominance of significant spatial groupings in the Central-South region of Brazil. In the multiple regression, statistically negative associations were observed between the Human Development Index (HDI) and OC age-standardized in the studied period (p < 0.05) and positive associations among the proportion of the population with dental appointment within last year, percentage of consumption of oils and fats, percentage of consumption of ready-to-eat foods and industrial mixtures and percentage of overweight adults with this type of cancer (p < 0.05). CONCLUSION: This is the first study that analyzed the factors associated to the spatial clusters of mortality due to oral cancer in the Brazilian FUs. A fairly unequal distribution of OC mortality rates was found, being that these rates presented inverse association with HDI and direct association with dental appointment, consumption of oils and fats, ready-to-eat foods and industrial mixtures consumption and overweight these rates. It suggests the need to redirect Brazilian public policies aimed at combating them so that they cease to be temporary and become permanent.