Abstract
Aims: To identify factors related to advanced-stage diagnosis of oral cancer to disclose high-risk groups and facilitate early detection strategies. Study design: An ambispective cohort study on 88 consecutive patients treated from January 1998 to December 2003. Inclusion criteria: pathological diagnosis of OSCC (primary tumour) at any oral site and suffering from a tumour at any TNM stage. Variables considered: age, gender, smoking history, alcohol usage, tumour site, macroscopic pattern of the lesion, co-existing precancerous lesion, degree of differentiation, diagnostic delay and TNM stage. Results: A total of 88 patients (mean age 60±11.3; 65.9% males) entered the study. Most patients (54.5%) suffered no delayed diagnosis and 45.5% of the carcinomas were diagnosed at early stages (I-II). The most frequent clinical lesions were ulcers (70.5%). Most cases were well- and moderately-differentiated (91%). Univariate analyses revealed strong associations between advanced stages and moderate-poor differentiation (OR=4.2; 95%CI=1.6-10.9) or tumour site (floor of the mouth (OR=3.6; 95%CI=1.2-11.1); gingivae (OR=8.8; 95%CI=2.0-38.2); and retromolar trigone (OR=8.8; 95%CI=1.5-49.1)). Regression analysis recognised the site of the tumour and the degree of differentiation as significantly associated to high risk of late-stage diagnosis. Conclusions: Screening programmes designed to detect asymptomatic oral cancers should be prioritized. Educational interventions on the population and on the professionals should include a sound knowledge of the disease presentation, specifically on sites like floor of the mouth, gingivae and retromolar trigone. More studies are needed in order to analyse the part of tumour biology on the extension of the disease at the time of diagnosis. Key words: Oral cancer, advanced-stage, diagnosis, cohort study.
Highlights
Survival rates for oral cancer are very poor, and no remarkable improvements have occurred in recent decades despite advances in therapeutic interventions [1]
Up to a 54.5% of the patients in this series were diagnosed at late stages, and recognition of predictors for advanced-stage diagnosis could permit the development of strategies aimed at improving this percentage
The existence of precancerous lesions associated to the tumour did not seem to modify the extension of the disease at the moment of diagnosis, despite that proliferative verrucous leukoplakia or the presence of mild or moderate epithelial dysplasia at the margins of a surgically removed OSCC carries a significant risk of local recurrence and modifying prognosis [21]
Summary
Survival rates for oral cancer are very poor (around 50% overall), and no remarkable improvements have occurred in recent decades despite advances in therapeutic interventions [1]. An important number of studies have assessed the determinants for diagnostic delay (period elapsed since the first sign or symptom until definitive diagnosis) despite its controversial part in oral cancer [12,13,14], but the reports aimed at identifying predictors for diagnosis at advanced stages are very scarce though tumour stage is directly related to mortality by oral cancer. This study was designed to analyse the hypothetical factors related to diagnosis of oral cancer at advanced stages (III-IV) in order to identify high-risk groups for latestage diagnosis and facilitate early detection strategies
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