Oral Cavity Carcinoma Research Articles

Toxicity of Simultaneous Integrated Boost Intensity Modulated Radiation Therapy in Post-Operative Oral Cavity Cancer

To assess the acute toxicity of Simultaneous integrated boost intensity modulated radiation therapy (SIB-IMRT) in postoperative oral cavity cancers with intermediate risk features was the primary objective of this study. The secondary objectives were to assess late toxicity and efficacy. This was a prospective, interventional study conducted at a single center. Patient accrual was done from November 2017 to August 2018 and data was analyzed in November 2019. Patients of oral cavity carcinoma who underwent surgery and had at least one risk factor on histopathological evaluation i.e., T3/T4 stage, node positive without extra capsular extension, lymphovascular invasion (LVI), perineural invasion (PNI), close margin (<5 mm), depth of invasion ≥3 mm for tongue and ≥7 mm for buccal mucosa were included. All patients had indication for adjuvant RT alone without concurrent chemotherapy. Post-operative RT was delivered with SIB-IMRT technique using 6 MV X-rays on a Linear accelerator. A dose of 63.6 Gray (Gy) in 30 fractions was delivered to high risk clinical target volume (CTV), 54 Gy in 30 fractions to intermediate risk CTV and 51 Gy in 30 fractions to low risk CTV. Dose constraints for the spinal cord was Dmax ≤ 42Gy, PRV cord Dmax ≤ 48Gy, brainstem Dmax ≤50.4 Gy, each parotid Dmean ≤ 26 Gy. Weekly assessment was done during RT and acute radiation toxicities were recorded as per Radiation Therapy Oncology Group (RTOG) acute toxicity criteria in terms of oral mucositis (OM), skin toxicity and dysphagia. Subsequent visits were monthly for the first 3 months, 2 monthly for the next 6 months and 3 monthly thereafter. Clinical examination with an assessment of the late toxicity was done as per RTOG late morbidity scoring schema. Radiological imaging (CECT or MRI) was done at 3 months post RT. Statistical analysis was performed using statistical package for sciences (SPSS version 20.0). Survival analysis was done by Kaplan-Meier method with log rank test. A total of 30 patients were included in the study with a median age of 48.5 years (range 33-75 year). The frequency N (%) of primary site involved was tongue 13(43.33), buccal mucosa 12(40), alveolus 4 (13.33) and retromolar trigone 1 (3.33). All patients completed RT and the median duration of RT was 42 days [mean days 42.3±0.93]. Maximum acute grade ≤2 vs grade 3 oral mucositis was 46.67% vs 53.33%, skin toxicity was 86.67% vs 13.33 %, dysphagia was 66.67% vs 33.33% respectively. No patients had grade 4 or 5 acute toxicity. At a median follow up of 11 months [range 6-18 month], grade 1 late toxicities were 53.33% (subcutaneous toxicity) and 33.33% (xerostomia). Loco regional control was 96.67%. IMRT-SIB is safe in terms of acute toxicity however the short follow up duration limits assessment of late toxicity and locoregional control rates in post-operative oral cavity cancers with intermediate risk.Abstract 3966; TableRisk factor for adjuvant RTN (%)>pT316(53.33)p N+9(30)PNI+11(36.67)LVI+5(16.67)Close margin1(3.33)DOI20(66.67) Open table in a new tab

Induction chemotherapy in nonlaryngeal human papilloma virus-negative high-risk head and neck cancer: a real-world experience.

The role of induction chemotherapy in the multidisciplinary treatment of locally advanced, nonlaryngeal high-risk human papilloma virus (HPV)-negative head and neck squamous cells carcinoma (HNSCC) is uncertain in terms of overall survival (OS). The primary objective of this study was to identify possible predictive factors of survival and outcome in patients with HNSCC who were treated with induction chemotherapy. Fifty-nine patients with stage IVa/b HPV-negative non-laryngeal HNSCC (mostly originating from the oral cavity) who underwent induction chemotherapy at Policlinico Umberto I were reviewed. Treatment outcomes in term of objective response rate (ORR), progression-free survival (PFS), OS and toxicities were analyzed. A significant association between nodal status, ORR, ongoing smoking use, toxicities and OS was demonstrated. ORR (obtained in 61% of patients) was associated with a reduction in mortality of 80% (P< 0.0001). Early discontinuation after just one cycle of induction chemotherapy was associated to a significantly shorter OS. In oral cavity radical surgery with negative margins was obtained in 15/16 patients. In 42% of patients G3-G4 toxicity occurred. Toxicity requiring hospitalization occurred in 42% and 21% of patients with oropharyngeal and oral cavity carcinoma, respectively. Five patients died of treatment-related causes. No treatment-related mortality occurred in oral cavity patients. G5 toxicities were different according to the sub-sites of disease (P = 0.05). Induction chemotherapy in non-laryngeal high-risk HNSCC is an active strategy, most importantly in oral cavity cancer, even though burdened with a high (G ≥ 3) toxicity and early discontinuation rate. These data will however need to be confirmed in further and larger studies.

Impact of Preoperative Imaging on Identifying Rapid Recurrence in Head and Neck Cancer

Rapid recurrence, defined as detectable tumor recrudescence after an oncologically sound primary operation but prior to initiating postoperative radiation therapy (PORT), is now recognized to be an underreported poor prognostic factor in head and neck cancer (HNC), occurring at a rate of 15-30% across different series. We sought to determine and analyze the impact of preoperative imaging on detection of rapid recurrence at the time of Computer Tomography (CT) simulation. CT simulation images of HNC patients treated with primary surgery and PORT between 2009 and 2017 were retrospectively reviewed by a neuroradiologist blinded to patient outcome but provided with pre-operative imaging and the surgical pathology report. Findings in the operative bed, ipsilateral neck and/or contralateral neck considered either suspected or definite recurrence were categorized as rapid recurrence. Multivariable analysis (MVA) was conducted to ascertain risk factors for rapid recurrence. Variables included were: days between imaging and surgery, number of imaging modalities, extranodal extension (ENE), lymphovascular invasion (LVI), perineural invasion (PNI), and pathologic stage. A total of 188 HNC patients were included with oral cavity and squamous cell carcinoma being the most common subsite (58%) and histology (84%). Overall, 22% had ENE, 24% had LVI, 45% had PNI, and 77% were AJCC 7th edition pathologic stage III/IV. Thirty-eight patients (20%) were identified to have rapid recurrence, of which 21 were at the operative bed, 17 were at the ipsilateral neck and 13 were at the contralateral neck. 13 patients (34%) had rapid recurrence at multiple sites. The median time between initial imaging and day of surgery for patients with and without rapid recurrence was 24.5 and 27 days, respectively (p= 0.28). Pre-operative imaging modality included CT, Magnetic Resonance Imaging (MRI) and Positron Emission Tomography fused to CT dataset (PET/CT). 107 patients (57%) had a single imaging modality and among them 86 had CT, 13 had MRI, and 8 had PET/CT. 81 patients (43%) had > 1 imaging modality; most frequently anatomic imaging (CT and/or MRI) and PET/CT (81%). The median time from initial imaging and day of surgery in patients with 1 and > 1 imaging modality were 24 and 31 days, respectively (p= 0.02). On MVA, patients with pre-operative PET/CT were less likely to have local or regional rapid recurrence (OR=0.30, 95% CI 0.13-0.73, p< 0.01). ENE was a predictor of rapid recurrence (OR 2.7, 95% CI 1.01-7.4, p= 0.05). There were no difference in ENE, LVI, PNI or pathologic stage in patients with and without PET/CT. The time between the initial imaging and the date of operation was not associated with rapid recurrence. Patients evaluated with functional preoperative imaging modalities were less likely to have rapid recurrence at the primary site and/or neck(s) at the time of CT simulation.

Does the Incorporation of Chemotherapy to Adjuvant Radiation Skew the Influence of Treatment Package Time in High-risk Oral Cavity Carcinoma? A Multi-institutional Collaborative Study

Does the Incorporation of Chemotherapy to Adjuvant Radiation Skew the Influence of Treatment Package Time in High-risk Oral Cavity Carcinoma? A Multi-institutional Collaborative Study

Subcutaneous Randomized Nasolabial Flap: Our Experience.

Nasolabial flaps are one of the oldest methods of reconstruction. This study aims to observe the viability of a random-pattern subcutaneous nasolabial flap. Inpatients of carcinoma of oral cavity and nose undergoing excision with primary reconstruction from January 2014 to December 2019 were observed and followed-up. Their data including site of primary and post-operative complication was recorded. A total of 38 patients underwent reconstruction using nasolabial flap. Most cases were of buccal mucosa carcinoma (68.4%). Facial vessels were ligated in all except 7 cases and, only 1 (2.6%) showed total, and 3 (7.9%) showed partial flap necrosis. A subcutaneous nasolabial flap is simple, viable and easy to harvest. It is a random-pattern flap therefore; facial vessel preservation may not be a compulsion. Flap raised subcutaneously is thinner and thus inset is easy and bulk associated discomfort is avoided.

Non-operative management for oral cavity carcinoma: Definitive radiation therapy as a potential alternative treatment approach

PurposeTo determine the outcomes of oral cavity squamous cell cancer (OSCC) patients treated with non-surgical approach i.e. definitive intensity-modulated radiation therapy (IMRT). MethodsAll OSCC patients treated radically with IMRT (without primary surgery) between 2005–2014 were reviewed in a prospectively collected database. OSCC patients treated with definitive RT received concurrent chemotherapy except for early stage patients or those who declined or were unfit for chemotherapy. The 5-year local, and regional, distant control rates, disease-free, overall, and cancer-specific survival, and late toxicity were analyzed. ResultsAmong 1316 OSCC patients treated with curative-intent; 108 patients (8%) received non-operative management due to: medical inoperability (n = 14, 13%), surgical unresectability (n = 8, 7%), patient declined surgery (n = 15, 14%), attempted preservation of oral structure/function in view of required extensive surgery (n = 53, 49%) or extensive oropharyngeal involvement (n = 18, 17%). Sixty-eight (63%) were cT3-4, 38 (35%) were cN2-3, and 38 (35%) received concurrent chemotherapy. With a median follow-up of 52 months, the 5-year local, regional, distant control rate, disease-free, overall, and cancer-specific survival were 78%, 92%, 90%, 42%, 50%, and 76% respectively. Patients with cN2-3 had higher rate of 5-year distant metastasis (24% vs 3%, p = 0.001), with detrimental impact on DFS (p = 0.03) and OS (p < 0.02) on multivariable analysis. Grade ≥ 3 late toxicity was reported in 9% of patients (most common: grade 3 osteoradionecrosis in 6%). ConclusionsNon-operative management of OSCC resulted in a meaningful rate of locoregional control, and could be an alternative curative approach when primary surgery would be declined, unsuitable or unacceptably delayed.

The diagnostic and prognostic utility of insulin growth factor of squamous cell carcinoma in oral cavity.

Objective:The present study was conducted to find the utility of insulin growth factors (IGFs) as diagnostic and prognostic biochemical parameters in patients suffering from squamous cell carcinoma of oral cavity.Materials and Methods:A total of 360 male and female patients diagnosed with precancerous conditions (PCC) and oral squamous cell carcinoma (OSCC) of Stage I to IV were selected for the present study. Patients were interviewed using a structured questionnaire to ascertain their demographic and medical history. After completing the history and physical examination, patients were subjected to routine blood investigations along with determining insulin growth factor (IGF-1, IGFBP-3) levels. The data obtained were then subjected to statistical analysis using SPSS 20.0 version.Results:The mean values of IGF-1, insulin-like growth factor-binding protein-3 (IGFBP-3), and ratio of IGF-1 and IGFBP-3 were obtained. The intergroup comparison was done between PCC and all the stages of OSCC for all the IGFs. The result obtained was found to be statistically significant (P < 0.05).Conclusion:The present study concluded that a positive correlation was observed for various insulin growth factors (IGF-1, IGFBP-3; and ratio of IGF-1 and IGFBP-3) between OSCC and PCC such as erythroplakia and oral submucous fibrosis. Thus, the study highlighted the use of IGFs as diagnostic and prognostic parameters in patients suffering from cancerous conditions.

Expression of Vascular Endothelial Growth Factor in Patients With Premalignant Lesions and Squamous Cell Carcinoma of Oral Cavity.

To evaluate and compare expression of VEGF in patients of premalignant lesions and squamous cell carcinoma of oral cavity. The cross sectional observational study is undertaken at the department of otorhionolaryngology and pathology, PGIMER and Dr RML Hospital, New Delhi,from 1st Nov 2017 to 31st March 2019,with a sample size of 30 cases each of premalignant lesions and oral squamous cell carcinoma immunohistochemistry by polymer method. In the participants with oral SCC, VEGF expression of Score 1 was observed in verrucous and well differentiated tumor, Score 2 in moderately differentiated SCC & Score 3 in poorly differentiated SCC with a p value of 0.0001. The observed difference and value of proportion p, is statically significant. In this study we concluded that VEGF expression increases as the lesion progresses from premalignant lesions to oral squamous cell carcinoma and is strongly associated with lymph node status (N-staging). Thus, VEGF can be a target in chemotherapy and its therapeutic implications in the HNSCC needs further research. Levels of Evidence 1A: Systematic review of randomized control trials.

Reactive thrombocytosis in malignancy- Can it be a strong predictor for IT

An increased platelet number may be secondary to many conditions. Malignancies are known to induce thrombocytosis in some cases. In patients with malignancies, thrombocytosis has previously been related to disease stage, histological type, and survival. Studies have shown that thrombocytosis is associated with a poor prognosis in various malignancies such as carcinoma ovary, cervical cancer, endometrial cancer, breast cancer and lung cancer. The aim of this study was to analyze the etiology and prevalence of thrombocytosis in malignancy and to assess whether platelet count can be used as a predictor of malignancy in the cases diagnosed as cancer at the time of its first diagnosis. This descriptive study was done on 500 patients with platelet count &amp;#62; 450,000/ μl with the cause being termed reactive. The most common cause of reactive thrombocytosis was Infections (28.8%), Tissue damage (16.4%), Iron deficiency anemia (16.2%), Malignancy (9.6%) and Inflammation (9.4%). Among malignancies, carcinoma oral cavity (20.8%) was found to be more commonly associated with thrombocytosis; with only (4.2%) cases being less than 18 years, rest (95.8%) cases were above 18 years. Thrombocytosis is associated with various neoplasms, therefore it can be used as a diagnostic clue for malignancy in an undiagnosed patient presenting with reactive thrombocytosis and associated symptoms of the disease thus indicating poor outcomes and mortality.

Claudin expression is maintained in mucoepidermoid carcinoma of the salivary gland

ObjectiveThe aim of the present study was to investigate the expression of claudin-1, -3, -4, -5 and -7 proteins in mucoepidermoid carcinoma of oral cavity and analyze whether EGF may interfere in the expression of the genes that encode claudins using in vitro models. Material and methodsUsing immunohistochemistry, the expression of claudins was searched in 36 histologically graded cases of mucoepidermoid carcinoma. The association of expression of claudins with clinical-pathological parameters was evaluated. An in vitro step investigated the influence of EGF on gene expression of claudins by real time RT-PCR technique. ResultsClaudin-1, -3, -4, -5, and -7 were highly expressed in most mucoepidermoid carcinomas. These expressions were compared with clinicopathological parameters. High expression of claudin-1 was associated with patients over 40 years-old (p = 0.05) and Caucasians (p = 0.024). In vitro experiments demonstrated a tendency for Claudin gene expression increase after EGF stimulus. ConclusionsThe expression of claudins is maintained in mucoepidermoid carcinoma cells and EGF could be related with this expression. Our results point out to a fundamental biological importance to CLDNs in normal and neoplastic tissue. The expression patterns of CLDNs does not yet allow a clinical application, but the biological knowledge will ground evidence to new studies towards possible target-therapies.

Predictors of Occult Neck Metastasis and Extra Capsular Spread in Early Oral Cancers.

To investigate the incidence of occult neck metastasis and to determine the prognostic factors related to the occurrence of the cervical lymph nodal metastasis and extra capsular extension (ECE) in early oral cavity cancer patients. A retrospective review performed on 100 patients with node negative squamous cell carcinoma of oral cavity who underwent primary treatment between Jan 2015 and Dec 2018. Incidence of occult neck metastasis after the elective neck dissection in our study was 35%. Independent correlates of positive occult neck metastasis were lymphovascular Invasion (P-0.000)[CI 0.004-0.326] and depth of invasion(P-0.009)[CI 0.509-13.428] on univariate analysis and statistically significant factors associated with the incidence of the extracapsular extension were age(P-0.044), lymphovascular invasion(P-0.018)[CI 0.004-0.603] and lymph node ratio(P-0.000)[CI 4.570-158.45] on univariate analysis. Lymphovascular invasion and depth of invasion correlated significantly with occurrence of neck metastasis. Age and LVI were the prognostic factors for extra capsular spread.

Impact of extrinsic tongue muscle invasion on stage migration in AJCC 8th edition staging of oral cavity carcinoma.

Impact of extrinsic tongue muscle invasion on stage migration in AJCC 8th edition staging of oral cavity carcinoma.

Fluorescence-guided resection of tumors in mouse models of oral cancer

Complete removal and negative margins are the goal of any surgical resection of primary oral cavity carcinoma. Current approaches to determine tumor boundaries rely heavily on surgeons’ expertise, and final histopathological reports are usually only available days after surgery, precluding contemporaneous re-assessment of positive margins. Intraoperative optical imaging could address this unmet clinical need. Using mouse models of oral cavity carcinoma, we demonstrated that PARPi-FL, a fluorescent PARP inhibitor targeting the enzyme PARP1/2, can delineate oral cancer and accurately identify positive margins, both macroscopically and at cellular resolution. PARPi-FL also allowed identification of compromised margins based on fluorescence hotspots, which were not seen in margin-negative resections and control tongues. PARPi-FL was further able to differentiate tumor from low-grade dysplasia. Intravenous injection of PARPi-FL has significant potential for clinical translation and could aid surgeons in assessing oral cancer margins in vivo.

P-346 Endoscopic profiling of various GI malignancies in CMOSH Medical College Hospital, Chattogram, Bangladesh

The prevalence of GI malignancies in Chattogram, Bangladesh, is mostly unknown. We, gastroenterologists, often find various GI malignancies during gastro-duodenoscopy, colonoscopy and ERCP. However, we have no DATA regarding the epidemiology of these malignancies which are diagnosed endoscopically. We did this study to profile various GI malignancies diagnosed endoscopically at our centre. Moreover, we audited the endoscopy reports with diagnosis of GI cancer to improve the quality of our performance and reporting. Endoscopy reports of 93 consecutive patients presenting to the endoscopy suits of CMOSH from May 2017 until April 2019 and diagnosed as GI malignancies were retrospectively analyzed. The DATA regarding various procedures performed, age, and gender were recorded from the endoscopy reports. DATA on carcinoma of oral cavity, oesophagus, stomach, duodenum, ampullary, peri-ampullary region, bile duct, colon and rectum were analyzed using STATA software; version 13 (StataCorp, College Station, TX). Total number of subjects: 93; male 56 and female 37. Site of cancer: We found cancers in the oral cavity 3 (3.23%), oesophagus 22 (23.66%), stomach 31 (33.33%), Duodenum 3(3.23%), ampullary and periampullary 20 (21.51%), biliary 1 (1.08%), and rectum and colon 13 (13.98%). Among 22 oesophageal cancers the majority 18 (81.82%) involved lower oesophagus, 2 (9.09%) involved middle oesophagus. 2 (9.09%) involved upper oesophagus. Among 31 carcinoma stomach cases majority 17 (54.84%) involved antrum, 7(22.58%) involved body, 3 (9.68%) cardia, 2 (6.45%) fundus and 2(6.45%) pylorus. Among 13 colorectal cancers, 6 (46.15%) involved rectum, 4 (30.77%) sigmoid colon, 1 (7.69%) each in ascending, descending and transverse colon. Age group distribution of GI cancers: Age group distribution of our subjects was: 20 and below: 1 (1%), 21-30: 6 (6.45%), 31-40: 10 (10.75%), 41-50: 17 (18.28%), 51-60: 22 (23.66%), 61-70: 25 (26.88%), 71-80: 6 (6.45%), 81-90: 4 (4.30%) and 91 and above: 2 (2.15%). The subjects belonging to the 61-70 years age group had the most GI cancers in our study. Prevalence of cancer in this age group was: oral cavity 2, oesophagus 8, stomach 9, Duodenum 5 and rectum 1. Second age group was 51-60 years. Cancers found in this age group was: oesophagus 5, stomach 5, duodenum 9, rectum 1 and colon 2. Third age group was 41 to 50 years. Cancers which were prevalent in this age group were: oesophagus 2, stomach 5, duodenum 6, biliary 1, rectum 1 and colon 2. Gender distribution of GI cancers: Commonest cancer in female subjects was oesophagus 12, which was followed by stomach 8, colorectal 8, ampullary/preiampullary 4, duodenum 3 and biliary 1. Most common cancer in male subjects was gastric cancer 23, which was followed by ampullary/periampullary 16, oesophagus 10 and colorectal 5. Our subjects were predominantly male belonging to age group 61-70 and predominant cancer in our study was gastric cancer. The most common cancer in female subjects was carcinoma oesophagus and the most common cancer in our male subjects was carcinoma stomach. Although there were some minor differences in the reporting and occasional omission of details, we found the reporting quality as optimum.

Level I Nodal Positivity as a Factor for Involvement of the Submandibular Gland in Oral Cavity Carcinoma: A Case Series Report.

Introduction The routine practice of neck dissection in the surgical management of oral carcinoma has evolved into a more functionally conservative approach. Over time, the rationale for removal of the submandibular gland has been questioned. Routine extirpation of the submandibular gland can aggravate the xerostomia experienced by many patients, significantly affecting their quality of life. Objective The objective of the present study was to determine the incidence of submandibular gland metastases in oral cavity carcinoma and to identify possible factors that may affect their involvement. Methods A total of 149 cases of oral carcinoma presenting at a private tertiary care hospital in Karachi, Pakistan, over the course of 1 year were reviewed retrospectively. Results Histopathological data showed that the submandibular gland was involved in 7 (4.7%) cases. Involvement of level I lymph nodes was found in all of the cases. Direct extension of primary tumor was noted in two cases when the primary tumor was in the floor of the mouth. Conclusion The results suggest that preservation of the submandibular gland during neck dissection for oral carcinoma can be practiced safely when there is no evidence of direct extension of the primary tumor toward the submandibular gland or when there is no clinical or radiological evidence of neck disease in level I. Presence of pathological lymph nodes in level I requires caution when contemplating preservation of the submandibular gland.

Oral Squamous Cell Carcinoma in Relation with Depth of Invasion and Lymph Node Metastasis

Background: Squamous cell carcinoma of oral cavity has become one of the most common malignancies in Nepal. Neck node involvement is frequently seen in this type of malignancy. Depth of invasion is one of the most important criteria for determining further management of the patient. This study is undertaken to see whether the depth of tumor invasion is a reliable parameter for predicting regional lymph node metastasis.&#x0D; Methods: This retrospective study was done among 85 patients of pathology department of the College of Medical Sciences Teaching Hospital, Bharatpur from May to Oct 2019. &#x0D; Results: This study found that most of the cases of oral squamous cell carcinoma had occurred in old age within 60-70 years of age. The most common site of occurrence for oral squamous cell carcinoma was tongue (60%), followed by lower alveolus (20%). The depth of invasion of 5mm and more was among 89% of the cases while cervical lymph node metastasis was among 53% cases. Most of the cases (60%) were well-differentiated (Grade I). There was no statistical relationship between depth of invasion and lymph node metastasis (p&gt;0.05).&#x0D; Conclusions: The most common site of oral squamous cell carcinoma was tongue. Depth of invasion was not a predictor for lymph node metastasis.&#x0D; Keywords: depth of invasion; lymph node metastasis; oral squamous cell carcinoma; simple compass divider.

Oral Cavity Cancer Outcomes in Remote, Betel Nut-Endemic Pacific Islands.

Oral cavity carcinomas individually are the fifth-leading cause of overall cancer mortality in the Northern Mariana Islands, which is likely a representative statistic for many other betel-nut-endemic Pacific islands. Factors associated with survival have been minimally evaluated in this region. The purpose of this study is to further characterize oral cavity carcinoma outcomes and associated prognostic factors in the United States commonwealth of the Northern Mariana Islands (CNMI). A single-institution retrospective review was undertaken for 81 patients diagnosed with head and neck cancers at the CNMI's only regional hospital complex from 2005 to 2019. A subset of patients diagnosed with oral cavity carcinoma was further evaluated for survival outcomes. Cox proportional hazard regressions were performed to evaluate for variables associated with survival. A majority of patients had cancer of the oral cavity (64/81, 79%). Fifty-five of these patients had sufficient data for review. The average age at the time of diagnosis was 48 and over half were diagnosed with stage IV disease (29/55, 53%). Five-year overall survival (OS) was 49.5% (95% CI, 33.3-63.7%). Factors associated with worse OS were lymph node metastases at presentation (P = .031), higher overall stage (III or IV vs I or II, P = .016), and higher T-stage (III or IV vs I or II, P = .027). Those who used betel nut were diagnosed at a significantly younger age than those who did not (47.2 vs 55.4, P = .001). The head and neck cancer burden in the CNMI is dominated by betel nut related oral cavity disease that is characterized by delayed presentations in younger patients and decreased OS. Future studies are indicated to improve health literacy as well as to investigate the potential for screening programs.

Abstract B40: Trends in lymph node yield for neck dissection and oral cavity carcinoma survival

Abstract Objectives: Lymph node yields (LNYs) following neck dissection have been associated with differences in oral cavity cancer survival. The objective of this study was to evaluate temporal trends in LNYs in neck dissections for oral cavity carcinoma. Methods: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER 18) database. Inclusion criteria included diagnosis of malignant oral cavity cancer (tongue and floor of mouth) squamous cell carcinomas diagnosed from January 1, 2006-December 31, 2016. Patients with AJCC 6th Edition Stages 1-4a who underwent surgery were included. All-cause age-adjusted mortality for tongue and floor of mouth cancers during this period was assessed using SEER*Stat. Results: The median LNY among 8,580 patients in the sample was 25 LNs (Interquartile range 14-39). LNY statistically increased over time from 22 LNs in 2004 to 27 in 2014 (p &amp;lt; 0.0001). In contrast, there was no change in the median number of positive LNs during the same period (median 2 positive LNs in 2004 and 2014). There was no significant difference in lymph node yield based on sex, region, insurance status, or relative location to a metropolitan center. After adjusting for patient age, sex, race, marital status, regional income, and percent current smokers in the county of residence, tumor subsite and TNM stage, LNY less than 18 was independently associated with a 44% greater risk of death from any cause, compared with greater LNYs (HR 1.44, 95% CI 1.29-1.60, p=.0001). During this period, all-cause age-adjusted mortality declined from 469.7 per 100,000 (468.2-471.2) to 429.0/100,000 (428.2-430.8). Conclusion: LNY following neck dissection for oral tongue and floor of mouth cancers increased significantly over a decade, during which survival also improved. The cause of improved LNY is not known but may nevertheless be contributing to declining mortality in patients with oral tongue and floor of mouth cancers. Citation Format: Punam Patel, Suraj Kedarisetty, Miriam Lango. Trends in lymph node yield for neck dissection and oral cavity carcinoma survival [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr B40.

A study of Ki 67, p53 and their combination as immunomarkers in squamous cell carcinoma of oral cavity

Background: Oral cancer is the most common cancer and constitutes a major health problem. Tobacco and alcohol remains the most important etiologic factors. Molecular level changes in the lesion occur before clinical and histopathological changes. The prognostic evaluation of this neoplasia is given by histological and immunohistochemical findings, including staging, histological grade, tumor size, lymph node involvement, immunohistochemical expression of p53 and Ki-67.In squamous cell carcinomas of oral cavity, p53 and Ki-67 are related to large tumors, metastasis to lymph nodes and very likely to a worse prognosis. Aim and objectives: To assess and compare the expression p53, Ki-67 and their combination markers in squamous cell carcinoma of oral cavity in relation to lymph node status, degree of histological differentiation and pathological staging. Materials and Methods: The prospective study was conducted in N.I.M.S medical college carried out with 108 cases of oral cavity squamous cell carcinoma with lymph node resection. The p53 and Ki-67 labelling indices were expressed as the percentage of Ki-67 and p53 immunolabelled tumor nuclei per 1000 tumor nuclei counted. Results: The maximum numbers of cases were found to be in the age group of 40-60 years (61.8%), mostly being men (85.1%). Female comprised of only 14.9% of the patients. All cases were subjected to immunohistochemical study for Ki- 67 and p53. Positive expression of Ki 67 detected was in 92 cases and p53 was detected in 72 cases. Both Ki -67 and p53 were positive in 58 cases. Ki -67 marker was tested in all 108 cases. Out of total 108 cases 92 (85.2%) were found to be positive for Ki -67 and only 16(14.8%) were found negative. In the histological grading 48 (44.4%) were low grade (well differentiated), and 30 (55.6%), were high grade (moderately and poorly differentiated). Out of 48 low grade cases 14(29.2%) cases and out of 60 high grade cases 44(73.3%) were positive for p53and Ki 67 which was statist

The KRAS mutation status and resistance to cetuximab in patients with squamous cell carcinoma of oral cavity.

e15514 Background: The standard treatment of squamous cell carcinoma of the tongue and the mucosa of the bottom of the oral cavity (SCCTOM) is chemotherapy (CT) in combination with cetuximab (mC, anti-EGFR antibody). However, not all patients manage to achieve positive results. A common cause of resistance to anti-EGFR antibodies is the constitutive activation of mediators of the underlying signaling pathways. Therefore, the aim of the study was to analyze mutations in the KRAS using the Digital Droplet PCR method in patients with SCCTOM on the background of CT in combination with targeted therapy or standard CT. Methods: The study used the QX200 system (Bio-Rad) and the ddPCRtm KRAS Screening Multiplex Kit (7 mutations). The study included 60 patients with T3-4N0-1M0 SCCTOM. The main group consisted of 30 patients (cisplatin, 5-fluorouracil+cetuximab). The control group consisted of 30 patients (CT). For research, cfDNA from blood plasma was used. Analysis of the data was performed using QuantaSoft v1.7.4. Results: The frequency of the KRAS mutant type (mtKRAS) is 43% before treatment and 32% after treatment (n = 60). In the group of patients CT+mC the incidence of mtKRAS before treatment was 40%, after treatment - 20%. In the group of patients CT without mC the incidence of mtKRAS before treatment was 47%, after treatment - 43%. Decrease of 20% (p = 0.00089) in the frequency of mtKRAS after CT+mC was found, while it was 23% (p = 0.00009) lower than the frequency of mtKRAS after CT without mC. After treatment, in the CT+mC group of patients, the number of mtKRAS DNA copies increased 1.5 times (p = 0.048). Analysis of clinical response to therapy allowed us to divide the main and control groups of patients into 2: sensitive and resistant to therapy. After treatment, a change in the mtKRAS ratio was not found in the subgroup sensitive to mC compared with the period before treatment, while the frequency of mtKRAS was reduced by 3 times (p = 0.009). In the mC-resistant subgroup, the mtKRAS ratio increased 1.9 times compared to the period before treatment (p = 0.009), while the frequency of mtKRAS increased 3.5 times compared with the mC-sensitive group (p = 0.0045). Conclusions: Prior to treatment, patients resistant to CT+mC were characterized by an increased occurrence of mutations in the KRAS and an apparently large number of tumor cells carrying mutations. The use of mCs caused a change in the direction of the clonal evolution of tumor cells - leading to an increase in the number of cells carrying mtKRAS (conditions were created for the elimination of cells with mutation in EGFR and KRAS wild type).