OP179: Outcomes of immunocompromised patients with SCC of the oral cavity – A case controlled study at the University of Minnesota

Abstract

Introduction Squamous cell carcinoma is the most common cancer of the head and neck with an overall high morbidity, high mortality and relative few therapeutic options. Immunosupression has generally been thought to lead to a poorer outcome however to date no study has validated this hypothesis. This study is a single institution case controlled retrospective study examining the influence of immunosuppression on the development of oral cavity SCC with treatment and prognostic influence. Methods A retrospective review was conducted of the tumor registry within the department of Oral and Maxillofacial Surgery from 2008 to present. Inclusion criteria were any patients with a history of autoimmune disease, lymphatic malignancies, history of requirement for BMT and other systemic comorbities that lead to immunosuppression like uncontrolled diabetes. Exclusion parameters were patients below the age of 18 years of age. Results Chart from the head and neck cancer clinic from 2008 to 2012 were reviewed and 19 patients out of 156 patients met the inclusion criteria. Only patients with SCC of the oral cavity were included. There was no difference in the differentiation level or perineural/angiolymphatic involvement between the two groups. The recurrence rate of patients with immunosuppression was higher when compared to controls (35% for immunosuppression compared to 9% for controls). The depth of the tumors at initial staging was greater than 3 mm for 79% of patients who were immunocompromised compared to only 48% for controls. Conclusions Immunocompromised patients do seem to have a more aggressive tumor compared to controls. Despite no difference in the histological grade of the tumor, patients who are immunocompromised do have a higher recurrence rate and therefore a poorer overall survival compared to control patients. The depths of these tumors are greater in the immunocompromised group and possibly lead to distant disease, which compromises their overall survival. Further studies in the molecular immunobiology of the disease are needed to better understand this disease process.