Peri-Neural Invasion Is an Important Prognostic Factor of T2N0 Oral Cancer.

Background and objectives: Among patients with pathologically proven T2N0 oral squamous cell carcinoma (OSCC), a notable amount of patients still die from tumor recurrence although they have radical surgery for early stage cancers. In literature, the prognostic indicators of this specific disease entity were rarely reported. This study aims at analyzing the prognostic factors of T2N0 OSCC patients and discussing possible managements to improve the survival. MATERIALS AND METHODS: From January 2012 to December 2017, the data of 166 pathologically proven T2N0 oral cancer patients proved by radical surgery were retrospectively collected. The clinical and pathologic factors including age, gender, tumor differentiation grade, perineural invasion (PNI), angiolymphatic invasion (ALI), margin status, and adjuvant therapy were analyzed by univariate and multivariate analysis to determine their association with disease-specific survival (DSS), and disease-free survival (DFS), which were calculated by Kaplan-Meier method. RESULTS: After median follow up time of 43.5 months, overall 3-year rates of DSS and DFS were 86.1% and 80.1% respectively for our 166 patients. Univariate analysis showed that the 3-year DSS of 90.8% for PNI negative patients was significantly better than DSS of 57.0% for PNI positive patients (p = 0.0006). The 3-year DFS of 84.2% for PNI negative patients was also significantly better than DFS of 54.6% for PNI positive patients (p = 0.001). Further multivariate analysis revealed PNI was the only independent prognostic factor associated with both DSS (Hazard Ratio (HR) = 5.02; 95% Confidence Interval (CI) = 1.99-12.6; p = 0.001), and DFS (HR = 3.92; 95% CI = 1.65-9.32; p = 0.002). Nearly 10% (16) of the 166 patients had adverse pathologic feature of PNI only. In the 11 patients without adjuvant therapy, 5 patients died from OSCC. No patients had recurrence or mortality after they received adjuvant therapy with chemotherapy ± radiotherapy. CONCLUSION: PNI was an independent prognostic factor for T2N0 oral cancer patients. Adjuvant chemotherapy and radiotherapy may benefit the survival of this specific disease entity, but further investigations are needed to elucidate the optimal regimen.

Introduction of a New Mandibular Reconstruction Procedure Using a Sagittal Split: A Case Report.

Soft tissue excision and segmental mandibular resection for the treatment of benign or malignant oral tumors result in surgical defects of varying extents. These procedures are often followed by adjuvant chemotherapy and radiotherapy, which induce further adverse events with limited available treatment options. To reduce the morbidity and enhance the success rate of mandibular reconstruction, we developed a novel technique that combines a sagittal mandibular split and the use of a vascularized forearm flap graft. Here, we describe our experience with this procedure in an older male patient. The bridging bone segment was pedicled using the mylohyoid muscle and periosteum, and a reliable vascularized forearm graft was used to repair the soft tissue defect. The patient experienced a rapid recovery, and a two-year follow-up revealed that the bone and skin grafts tolerated radiotherapy well. We conclude that this technique is a viable alternative for patients with a bony gap around 4 cm or in whom a vascularized fibular flap graft is contraindicated.

Developing a Biosensor-Based Immunoassay to Detect HPV E6 Oncoprotein in the Saliva Rinse Fluid of Oral Cancer Patients.

Transmission of Human papillomavirus (HPVs) is faithfully associated with carcinogenesis of oral cavity and oropharyngeal cancers. Therefore, clinical researchers may need to generate customized antibodies for the upcoming ELISA-based analysis to discover rare but valuable biomarkers. The aim of study was to develop and generate a biosensor-based immunoassay for early screening HPV-related oral cancer via saliva rinse fluid analysis. A peptide fragment of high-risk HPV subtype 16/18 protein, E6 protein (HP-1 protein sequence 48-66), was designed and synthesized, followed by the generation of polyclonal antibodies (anti-HP1 IgY) in our university-based laboratories. The titer and specificity of antibodies were determined by enzyme-linked immunosorbent assay (ELISA), and the Surface Plasmon Resonance (SPR) biosensor-based method was developed. Kinetic analyses by SPR confirmed that this designed peptide showed a high affinity with its generated polyclonal antibodies. Saliva fluid samples of thirty oral cancer patients and 13 healthy subjects were analyzed. SPR indicated that 26.8% of oral cancer patients had higher resonance unit (ΔRU) values than normal subjects. In conclusion, we developed a biosensor-based immunoassay to detect HPV E6 oncoprotein in the saliva rinse fluid for early screening and discrimination of HPV-related oral cancer patients.

WebPARE: web-computing for inferring genetic or transcriptional interactions.

SUMMARY: Inferring genetic or transcriptional interactions, when done successfully, may provide insights into biological processes or biochemical pathways of interest. Unfortunately, most computational algorithms require a certain level of programming expertise. To provide a simple web interface for users to infer interactions from time course gene expression data, we present WebPARE, which is based on the pattern recognition algorithm (PARE). For expression data, in which each type of interaction (e.g. activator target) and the corresponding paired gene expression pattern are significantly associated, PARE uses a non-linear score to classify gene pairs of interest into a few subclasses of various time lags. In each subclass, PARE learns the parameters in the decision score using known interactions from biological experiments or published literature. Subsequently, the trained algorithm predicts interactions of a similar nature. Previously, PARE was shown to infer two sets of interactions in yeast successfully. Moreover, several predicted genetic interactions coincided with existing pathways; this indicates the potential of PARE in predicting partial pathway components. Given a list of gene pairs or genes of interest and expression data, WebPARE invokes PARE and outputs predicted interactions and their networks in directed graphs.

Socio-demographic factors in the prognosis of oral cancer patients.

The aim of this study was to determine the survival rate of oral cancer patients treated in a medical center in central Taiwan and to investigate whether socio-demographic factors influence their survival. We retrospectively reviewed 1010 chart records of oral cancer patients. Survival was analyzed by the Kaplan-Meier method and Cox proportional hazard model was used for investigating the relationship between socio-demographic factors and survival. The overall 5-year survival rate was 63.24%. Multivariate analysis revealed that those without religious belief tended to have higher probability of death than those who had religious belief (relative risk (RR): 2.057, p<0.001). In addition, those who were single, widow/widower or divorced/separated had a poorer prognosis than those who were married (RR: 1.528, p=0.008). Apart from clinical features, socio-demographic factors also significantly influenced the survival of oral cancer patients. Therefore, care providers should take socio-demographic issues into consideration aside from ordinary clinical health care.

Clinical implications of recent exodontia before diagnosis of gingival squamous cell carcinoma: A new classification.

BACKGROUND: The purpose of this study was to clarify the clinical implications of cases with recent dental extractions to establish a new classification of gingival squamous cell carcinoma (SCC). METHODS: A total of 156 patients were enrolled in this study. The subjects were divided into 3 groups: type I (dentate; n = 46), type II (edentulous; n = 55), and type III (dental extraction; n = 55). Continuous clinical and treatment variables were analyzed by 1-way analysis of variance (ANOVA) or t test, and categorical variables were evaluated by chi-square tests. Assessment of 5-year survival rates were carried out by the Kaplan-Meier analysis, and the influence of related factors was evaluated by the log-rank test. RESULT: The 55 type III patients showed a high probability of bony invasion (80%) and a lower 5-year survival rate (48%) than the other 2 groups. CONCLUSION: Our proposed classification may help clinicians to identify patients with gingival SCC who present with more advanced disease status.

Late intracranial haemorrhage and subsequent carotid-cavernous sinus fistula after fracture of the facial bones.

Carotid-cavernous sinus fistula is an arteriovenous fistula between the internal carotid artery and the cavernous sinus, and is usually caused by a traumatic tear or a ruptured aneurysm of the cavernous segment of the internal carotid artery. We describe a rare case of delayed intracranial haemorrhage and carotid-cavernous sinus fistula that presented 3 weeks after fracture of the facial bones. The patient developed orbital apex syndrome including ptosis of upper eyelid, pulsatile exophthalmos, chemosis, loss of ocular motility, monocular blindness on the right, and numbness of the right infraorbital region. After transcatheter intra-arterial embolisation, the ptosis and chemosis improved.

A preliminary study of the use of bioimpedance in the screening of squamous tongue cancer.

Oral cancers are the 11th most common malignancy reported worldwide, accounting for 3% of all newly diagnosed cancer cases, and one with high mortality ratios among all malignancies. The objective of this study was to study the electrical properties of cancerous tongue tissue (CTT) and normal tongue tissue (NTT). Five tongue cancer patients participated in this study. A disposable probe incorporating four silver electrodes was used to measure the electrical properties of CTT and the surrounding NTT of patients. Measurements were performed at six frequencies: 20 Hz; 50 kHz; 1.3 MHz; 2.5 MHz; 3.7 MHz; and 5 MHz, with the amplitude of the applied voltage limited to 200mV. Four measurement parameters of impedance (Z), phase angle (theta), real part of impedance (R), and imaginary part of impedance (X) of tongue tissue were assessed to see if there was any significant difference in the values obtained in CTT and surrounding NTT. The intraclass correlation coefficient showed that all measurements were reliable. A significant difference (P < 0.05 for the four measurement parameters) was found at 50kHz between CTT and surrounding NTT. It was also found that Z and R of CTT were generally smaller than that of surrounding NTT. In conclusion, bioimpedance at a particular frequency is a potentially promising technique for tongue cancer screening.

The use of bioimpedance in the detection/screening of tongue cancer.

Oral cancers are the 11th most common malignancy reported worldwide, accounting for 3% of all newly diagnosed cancer cases, and one with high mortality ratios among all malignancies. The objectives of this study were therefore to study the electrical properties of cancerous tongue tissue and normal tongue tissue, as well as to investigate a new approach for low-cost, noninvasive, and real-time screening of oral cancer. Twelve tongue cancer patients and twelve healthy subjects participated in this study. A disposable probe with four silver electrodes was used to measure the electrical properties of patient's and healthy subject's tongue tissues at six different frequencies, which were 20Hz, 50kHz, 1.3MHz, 2.5MHz, 3.7MHz and 5MHz. The amplitude of the applied voltage was limited to 200mV. Four measurement parameters of impedance, phase angle, real part of impedance, and imaginary part of impedance of tongue were assessed to see if significant difference in values obtained in patient's and healthy subject's tongue tissues existed. Intraclass correlation coefficient showed that all measurements had good reliability and validity (ICC>0.95 for all measurements). Significant differences were found at 20Hz (p<0.05-0.001 for the four measurement parameters) and 50kHz (p<0.001 for the four measurement parameters) between patient's and healthy subject's tongue tissues. In conclusion, bioimpedance at a particular frequency is a potentially promising technique for tongue cancer screening.

Nutritional factors and survival of patients with oral cancer.

BACKGROUND: Our objective was to determine the survival rate of patients with oral cancer who were treated at a medical center in central Taiwan. Furthermore, we attempted to investigate whether nutritional factors influence the survival. METHODS: We carried out a retrospective review of 1010 chart records of patients with oral cancer. We used the Kaplan-Meier method for survival analysis and the Cox proportional hazard models to investigate the prognosticators. RESULTS: Kaplan-Meier survival analysis showed an overall 5-year survival rate of 63.24%. The Cox proportional hazard model revealed that those with a preoperative body mass index (BMI) of <22.8 kg/m(2) tended to have a higher probability of death (relative risk [RR] = 1.292, p = .022). In addition, those with a preoperative serum albumin level of <4.15 g/dL were generally associated with a poorer prognosis (RR = 1.313, p = .016). CONCLUSIONS: Apart from clinical features, nutritional factors also had a significant influence on the survival of patients with oral cancer. Therefore, good nutritional status is crucial for patients with oral cancer in improving their survival.