Oral Cancer Patients Research Articles

Indigenous TrisCaRe® and Its Outcome in the Management of Trismus in Oral Cavity Cancer Patients: A Preliminary Report

Indigenous TrisCaRe® and Its Outcome in the Management of Trismus in Oral Cavity Cancer Patients: A Preliminary Report

Primary Care Referral Delays in Oral Cancer Diagnosis: A Meta-Analysis.

To measure the primary care interval (PCI) in the diagnostic delay of oral cancer and to assess the relation of the referring physician's specialty with disease stage at diagnosis. We meta-analyzed reports of oral/oropharyngeal carcinomas detailing PCI start- and endpoints, i.e., the time needed by a primary care physician to refer a suspected oral cancer patient to a specialist. 17 studies with a total of 2530 patients were eligible; nine provided data on the relative length of PCI, and 10 reported on the impact of the referring professional's specialty on oral cancer diagnostic delay. The average PCI length was slightly longer for general practitioners (GPs) (30.5 days) than for general dental practitioners (GDPs) (27.6 days), while that for the total group was 28.7 days. One-third of the total pre-hospital time spent on diagnosis elapses in GP practices (PCI%: 0.31 [95% CI: 0.23, 0.40]). GDPs refer their patients for treatment at earlier disease stages (TNM I-II) than GPs (Odds Ratio: 0.58; 95% CI: 0.34-0.98). Primary care accounts for a considerable pre-hospital amount of time of what is necessary for reaching a diagnosis of oral cancer patients. This calls for enhancing early oral cancer recognition in primary care settings.

Validation of salivary proteomic biomarkers for early detection of oral cancer in the Egyptian population.

The present study evaluated the sensitivity and specificity of important proteomic salivary biomarkers; IL-6, IL-8, and sCD44 in the early detection of oral cancer, and any possible associations with risk factors of oral cancer in an Egyptian population. The present investigation was conducted on 100 individuals; 25 healthy controls, 25 patients having oral potentially malignant disorders (OPMDs) with dysplasia; 25 patients having OPMDs without dysplasia, and 25 oral cancer patients. Demographic data modified gingival index, oral hygiene level, and salivary levels of the biomarkers were assessed. Salivary levels of IL-6, IL-8, and sCD44 progressively increased with increased disease severity. Salivary IL-8 and IL-6 levels possess a discriminating potential from normal tissue through different degrees of dysplasia to oral cancer, sCD44 levels had a discriminating power between normal and dysplastic tissues with high sensitivity and specificity. A positive correlation was found between the three biomarkers and the grade of oral squamous cell carcinoma (OSCC) and with different risk factors. This is the first study that evaluated multiple salivary proteomic biomarkers in the Egyptian population, and the results validate the ability of IL-6, IL-8, and sCD44 to be used as sensitive diagnostic and prognostic biomarkers for screening and early detection of oral cancer.

Efficacy of Oral Rehabilitation Techniques in Patients With Oral Cancer: A Systematic Review and Meta-Analysis.

Oral cancer commonly affects various parts of the oral cavity, including the lips, tongue, gums, palate, and inner cheeks. Oral rehabilitation involves multiple approaches aimed at restoring and improving oral function, esthetics, and overall well-being. This study assessed the functional outcomes and quality of life in patients who underwent rehabilitation following an oral cancer diagnosis. A comprehensive literature search was performed across PubMed, Cochrane Library, Dimensions, ScienceDirect, CINAHL, and Google Scholar databases. The study included patients diagnosed with oral cancer who had undergone oral rehabilitation. Functional outcomes and quality of life were key selection criteria. The methodological quality of the included studies was assessed, and data were systematically extracted and analyzed. A significant relationship was observed between the type of maxillectomy and quality of life, with obturator retention and stability being critical factors. Radiotherapy was found to adversely impact oral function and implant survival rates, with a strong correlation between radiation treatment and reduced implant survival (p < 0.00001). Additionally, dentition and the timing of implant placement were associated with recurrence rates and adverse effects. The findings highlight the crucial role of oral rehabilitation in improving both functional outcomes and quality of life in oral cancer patients. This study underscores the importance of incorporating oral rehabilitation into oral cancer treatment to enhance patient recovery and overall health.

Clinical Research on Staged Functional Exercise for Donor Site Limb Rehabilitation After Vascularized Fibular Flap Surgery in Oral Cancer Patients

Clinical Research on Staged Functional Exercise for Donor Site Limb Rehabilitation After Vascularized Fibular Flap Surgery in Oral Cancer Patients

Assessing the role of Osteopontin in prognosis of Oral Squamous Cell Carcinoma- A Systematic Review.

Oral cancer is always a global burden. It is the sixteenth most common cancer. It leads to metastasis since it is often diagnosed at late stages. To monitor the progress of this condition, various biomarkers are being utilized. Osteopontin is one such biomarker and its level in bodily fluids can be used as a reliable biomarker. The current study aims to review and evaluate the prognostic role of osteopontin in oral squamous cell carcinoma. A literature search was conducted across various databases such as Scopus, PubMed and Google Scholar. It yielded 18 articles totally using MeSH terms. The inclusion criteria were original research articles written only in English language involving both tissue and plasma osteopontin on oral cancer patients. Of these, only two articles which met the inclusion criteria were added into this systematic review. The search had no time restriction. The studies showed that osteopontin play a vital role in the prognosis of the OSCC patients. One study from Taiwan and other from India proved the osteopontin expression in plasma and tissue can help to predict the prognosis of patients with oral cancer. Also, the level of plasma osteopontin was correlated with aggressiveness of OSCC. Tissue osteopontin expression was significantly lower in stage I OSCC patients when compared with stage II and III. Since there were only two studies, there is limited evidence of results. From these findings, osteopontin can also be used as a reliable biomarker to predict the prognosis of oral cancer. Since there were only two studies to substantiate the finding, there is limited evidence and more studies are warranted to confirm the results.

Construction and verification of prediction model for postoperative hypokalemia in patients with oral cancer.

This study aimed to explore the risk factors of postoperative hypokalemia in patients with oral cancer and to provide a basis for preventing and controlling postoperative hypokalemia. We included 366 patients undergoing oral cancer surgery in the Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University from January 2022 to August 2022. Univariate and multivariate analyses were used to determine the risk factors of postoperative hypokalemia. The receiver operation characteristic (ROC) curve was used to quantify the effectiveness of the factors. A nomogram of the risk factors for postoperative hypokalemia in oral cancer patients was developed and validated. A total of 224 patients (61.20%) had postoperative hypokalemia, the lowest serum potassium level (3.50±0.35) mmol/L on the 4th day after surgery, and the highest incidence of hypokalemia (54.68%). Variables with P<0.05 in the univariate analysis were quantified by ROC curve followed by multivariate logistic regression analysis. Results showed an independent correlation with postoperative hypokalemia as follows: preoperative serum potassium<3.87 mmol/L (P=0.008), preoperative serum calcium<2.31 mmol/L (P=0.033), preoperative PNI<49.16 (P=0.032), postoperative drainage volume>264.25 mL (P=0.002). The above variables were constructed into a postoperative hypokalemia risk nomogram and verified, and a good degree of fit was found. The independent risk factors for postoperative hypokalemia in patients with oral cancer were as follows: preoperative serum potassium<3.87 mmol/L, preoperative serum calcium<2.31 mmol/L, preoperative PNI<49.16, and postoperative drainage volume>264.25 mL. Clinical attention should be paid to managing the above high-risk patients. Preventive potassium supplementation should be performed as soon as possible to reduce hypokalemia occurrence.

Swallowing outcomes in brachytherapy radiation approach for head and neck cancer survivors- A twin case-based observations

Swallowing dysfunction is a prevailing state following radiotherapy in patients with head and neck cancer. The progress in the treatment techniques has allowed more precise radiation administration to the tumour and has reduced damage to adjacent issues. Nonetheless, a proportion of patients still suffer from swallowing dysfunction following radiotherapy. Brachytherapy is an advanced procedure to treat and manage cancers increasing in recent clinical practice. BT has been used as a tool to facilitate the delivery of a high tumour dose in which it eventually reduces the doses to neighbouring swallowing structures, compared with conventional RT. There are no studies reported the swallowing abilities following brachytherapy. Hence considering the lacunae in the literature and the effect of radiation on swallowing abilities the present case study was taken to represent the swallowing abilities in oral cancer patients received brachytherapy. Two cases diagnosed with carcinoma of buccal mucosa and tongue were given brachytherapy. The speech and swallowing abilities were affected in both the condition prior to brachytherapy. Following brachytherapy speech and swallow rehabilitation was carried out for one month and both of them showed significant improvement and case with buccal mucosa showed greater improvement than carcinoma of tongue. The present concludes that there will be organ specific dysphagia symptoms in brachytherapy and involvement of adjacent structures are minimal.

Discussion on Rehabilitation in Oral Cancer Patients From Surgery to Final Prosthesis.

Discussion on Rehabilitation in Oral Cancer Patients From Surgery to Final Prosthesis.

Low Skeletal Muscle Mass: A Strong Predictive Factor for Surgical Complications After Free Forearm Flap Reconstruction in Oral Cancer Patients.

Low skeletal muscle mass (SMM) is a predictive factor for complications in patients undergoing major head and neck cancer surgery. This study aims to identify the predictive value of low SMM for postoperative complications in patients who underwent free forearm flap (FAFF) reconstructions after oral cancer resections. A retrospective study was performed with all patients who underwent FFAF between 2003 and 2020 for an oral cavity reconstruction after cancer ablation. Free flap related, any postoperative complications and hospital stay were investigated. Low SMM was associated with an increased risk of free flap associated complications (OR 2.14; 95% CI 1.02-4.39, p = 0.029). Low SMM was associated with severe complications (Clavien-Dindo ≥ III) (OR 1.46; 95% CI 1.20-2.09, p = 0.02). Low SMM is a strong predictive factor for free flap related surgical complications in patients undergoing FAFF reconstruction after resection of oral cancer.

Factors associated with the survival of oral cavity cancer patients: a single institution experience from Karachi, Pakistan

BackgroundOral cavity cancer (OCC) represents a significant public health burden in South Asia, ranking as the most prevalent cancer affecting males in Pakistan and contributing considerably to morbidity and mortality. The objective of this study was to evaluate the survival rates in patients diagnosed with OCC in the Pakistani population and identify the factors influencing survival.MethodsThis was a retrospective cohort study conducted at the Aga Khan University Hospital Karachi, Pakistan. A total of 2238 cases diagnosed with OCC from May 2011 through December 2020, who met the inclusion criteria, were included. Survival analyses at 1-, 3- and 5-year intervals were performed using the Kaplan-Meier method. Adjusted hazard ratios (HR) and their 95% confidence intervals (CIs) were estimated using a Cox regression model to identify the factors significantly influencing survival.ResultsAmong all cases, 54.0% were diagnosed in individuals 50 years of age and below and 73.0% were tobacco users. Overall survival, 1-year, 3-year, and 5-year survival rates were 54.9%, 88.9%, 81.6%, and 75.9% respectively. After adjustment for all the significant confounding and prognostic factors, age was an important factor showing that adults > 50 years had poorer survival compared to ≤ 50 years (HR = 1.43, 95% CI = 1.11–1.83). Poorly differentiated grade of OCC compared to well-differentiated grade (HR = 2.49, 95% CI = 1.61–3.84) and stage IV compared to earlier stages (HR = 3.56, 95% CI = 2.13–5.94) were also associated with poor survival.ConclusionNotably, there was a high occurrence of late stage (III and IV) OCC in individuals aged ≤ 50 years, with the buccal mucosa being the most common site involved. Moreover, a large proportion of our patients had a history of tobacco use. Patients with advanced-stage disease and poorly differentiated grade showed poor survival. Therefore, public awareness about tobacco control for OCC prevention and earlier diagnosis of OCC is urgently needed in our Pakistani population.

Association between the variations in metabolic pathways and oral cancer risk: results from a Pakistani case-control study.

Oral cancer (OC) is a significant global health concern, with Pakistan ranking 5th worldwide in OC incidence. Given the poor prognosis, early detection of at-risk individuals is crucial. Genetic factors, particularly single nucleotide polymorphisms (SNPs) in metabolic genes, may influence OC susceptibility. This study investigated the association between SNPs in CYP1A1, COX2, SOD2, and HIF1a genes and OC risk in the Pakistani population. A prospective study was conducted from October 2019 to March 2022, enrolling 215 newly diagnosed OC patients and 410 controls. Genetic variations were analyzed using High-Resolution Melting (HRM)analysis and Sanger sequencing, with protein expression evaluated by ELISA. No significant associations were found between the studied SNPs and OC risk. However, a non-significant trend was observed for the SOD2 variant (rs4880), where the G allele was associated with a higher OC risk than the A allele (p = 0.20). Elevated COX2 and HIF1α levels (p-values of 0.014 and <0.001, respectively) and reduced SOD2 levels (p < 0.0001) were observed in OC patients, while CYP1A1 levels remained similar in both controls and cases. Although SNPs in CYP1A1, COX2, SOD2, and HIF1α were not significantly associated with OC risk in the Pakistani population, altered protein expression levels of COX2, HIF1α and SOD2 suggest additional regulatory mechanisms. Further investigation into post-transcriptional modifications and epigenetic factors could lead to novel biomarkers and therapeutic targets for OC in Pakistan.

Convolutional neural network for oral cancer detection combined with improved tunicate swarm algorithm to detect oral cancer

Early Diagnosis of oral cancer is very important and can save you from some oral malignancies. However, while this approach aids in the rapid healing of patients and the preservation of their lives, there are several causes for poor and wrong diagnosis of oral cancer. In recent years, the use of computer-aided design diagnosis tools as an auxiliary tool alongside clinicians has greatly benefited in more accurate identification of this malignancy. The current study proposes a new approach for identifying oral cancer patients based on image processing and deep learning. The current study employs a recently integrated model of an improved tunicate swarm algorithm to produce an efficient tool for improving a convolutional neural network and delivering an accurate cancer diagnostic system. The approach is then implemented on the oral cancer pictures dataset. The approach is then validated by comparing it to other published papers using various measurement markers. The proposed model achieved an accuracy of 98.70% and a recall of 93.71% in detecting oral cancerous lesions from photographic images. The model also achieved an F1-score of 90.08% and a precision of 96.42%. The final results demonstrate that the offered approach can produce more exact results and can be used in conjunction with clinicians to help in diagnosing oral cancer.

A Prediction Model for Lymph Node Metastasis of Oral Squamous Cell Carcinoma Based on Multiple Risk Factors.

Cervical lymph node metastasis (CLNM) frequently occurs in oral cancer patients. This study aims to investigate risk factors associated with CLNM and predict CLNM preoperatively in patients with oral squamous cell carcinoma (OSCC). This population-based, hospital retrospective cohort study included 158 patients with oral cancer. We performed regression analysis to determine risk factors and establish a model for predicting CLNM in patients with OSCC. To distinguish and validate the prediction model, we used the area under the receiver operating characteristic (ROC) curve (AUC). Lymph node size, tumor size, degree of differentiation, and LVI were risk factors for cancer metastasis. The OR values were 1.245, 2.847, 2.527, and 6.945, respectively. The AUC value for the clinical prediction model was 0.8736 (95% CI: 0.8043-0.9429). The prediction model for OSCC patients predicts CLNM and provides a new method for preoperative assessment of whether cervical lymph nodes are metastatic, as well as a guide for surgical treatment, including whether to carry out neck dissection and which neck dissection procedure to use.

Multidisciplinary tumor boards in oral cavity cancer: survival effect due to balancing guideline adherence and treatment delays.

The purpose of the study was to assess the impact of a pretherapeutic Multidisciplinary Tumor Board (MTB) presentation on the prognosis and treatment outcomes in patients with primary oral cavity carcinoma. This single-center study included 630 patients diagnosed with oral cavity carcinoma treated between 2010 and 2020. The study cohort was divided in a group with and without pretherapeutic MTB presentation. Data on patient demographics, tumor characteristics, treatment and the time to treatment initiation (TTI) were collected retrospectively. Primary findings revealed no significant difference in 3-year survival rate (3-YSR) and 3-year disease-free survival rate (3-YDFSR) for the non-MTB and MTB group. The 3-YSR was 73.1% in the non-MTB group and 67.1% in the MTB group (p = 0.112). The 3-YDFSR was 73.8% in the non-MTB group and 76.5% in the MTB group (p = 0.447). Estimated mean 5-year survival (5-YS) and 5-year disease-free survival in (5-YDFS) did not differ significantly between both groups, across the UICC stages I-IV, as well as for the entire cohort. The TTI was significantly longer in the MTB group (33.5 days, CI: 31.3;35.7) compared to the non-MTB group (20.1 days, CI: 17.9;22.4, p < 0.001). The MTB group adhered more frequently to the national guidelines (68% vs. 79.6%, p < 0.01). The results demonstrate both positive and negative side effects of the MTB presentation in patients with oral cavity cancer. Further multicenter studies will be required to assess the impact of TTI and adherence to guidelines on the survival of oral cavity cancer patients.

Cytokines levels in saliva in periodontitis, oral potentially malignant disorders and squamous cell carcinoma

Biopsy and histopathological examination continue to be the gold standards for diagnosing oral cancer and oral potentially malignant disorders (OPMD). The prognosis of these conditions is significantly influenced by established factors such as the degree of dysplasia, tumour size, grade, and patient age. While these traditional diagnostic approaches are crucial, there is a growing need for innovative methods to improve diagnosis and monitoring of these conditions. We hypothesize that identifying specific diagnostic biomarkers in human saliva, alongside traditional methods, could enhance clinical outcomes in managing both malignant and non-malignant oral pathologies. In this study, salivary levels of previously described biomarkers BDNF, IL-6, IL-8, IL-10, IL-15, IL-1RA, LIF, and TNF-α were compared among oral cancer patients, patients with OPMD, periodontal disease patients, and healthy volunteers. The results indicated that these cytokines have the potential to distinguish cancer cases, though they are less effective in differentiating between OPMD and periodontitis. Using pairs or groups of biomolecules could improve the ability to differentiate between different pathological entities. We found the following panel IL-6, IL-15, and IL-1RA to be particularly significant as diagnostic biomarkers for oral squamous cell carcinoma and OPMD.

Causes of death after oral cancer diagnosis: a population based study.

Nowadays, the number of oral cancer survivors is increasing, emphasizing the importance of thoroughly understanding diverse causes of death in oral cancer survivors. Our study aimed to investigate the distribution of causes of death after oral cancer diagnosis. Eligible patients were identified between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. We calculated the number of deaths in different demographic and clinicopathological variables during each follow-up period. Standardized mortality ratios(SMRs) were generated for each cause of death after oral cancer diagnosis. A total of 30538 patients diagnosed with oral cancer were included, and 17654 deaths were reported during follow-up period. 27.08% of deaths were caused by non-caner reasons. The proportion of non-cancer related deaths increased with the extension of survival time, and non-cancer death accounted for 57.93% of all deaths when followed up more than 10 years. The most common non-cancer cause of death was cardiovascular disease (SMR 4.68#; 95%CI 4.46-4.92). Non-cancer causes of death should not be ignored in oral cancer patients. For oral cancer survivors, multidisciplinary follow-up strategy should be recommended to achieve longer survival time.

Comparative Study on the Application Effects of Optimized Frozen Section Procedure in Oral Cancer Surgery.

Objective. To investigate the application effects of optimizing the frozen section procedure in oral cancer surgery. Methods. A total of 45 oral cancer patients undergoing surgery were selected as the control group, operated from January 2020 to May 2021, without optimization of the frozen section procedure. Another 45 oral cancer patients undergoing surgery were selected as the experimental group, operated from June 2021 to December 2022, with the optimized frozen section procedure. The differences in the excellent rate of sections, the preparation time, the frozen report time and the accuracy rate between the two groups were compared. Results. In terms of the excellent rate of sections, the optimized procedure group was (44/45) 97.8%, which was higher than the conventional group (40/45) 88.9%; the preparation time and frozen report time in the optimized procedure group were (9.2 ± 0.7) min, and (26.4 ± 2.2) min, respectively, both shorter than those in the conventional group were (12.3 ± 1.3) min, and (31.8 ± 2.7) min, (p < 0.05); the accuracy rate of the frozen report, the optimized procedure group was (43/45) 95.6%, which was higher than the conventional group (40/45) 88.9%. Conclusion. Optimizing the frozen section procedure in oral cancer surgery can achieve desirable results, conducive to improving slide quality, reducing preparation time, and overall frozen report time. It is worthy of promotion.

Comparison of oral cancer versus competing factors as cause of death: Single institution experience with long-term follow up

Survivors of head and neck squamous cell carcinoma face excess mortality from multiple causes. However, impact and patterns of all-cause mortality remains unknown in oral cancer patients. The aim of this study was to analyse these patterns in long-term survivors. We retrospectively studied clinically node-negative (cN0) oral cancer patients primarily surgically treated at tertiary cancer center. A total of 152 patients were identified. Median follow-up of our cohort was 59 months. A total of 76 patients died. Thirty-four (22.4%) patients died from primary tumor recurrence and 42 (27.6%) patients died from competing causes. The most common competing causes of death were: cardiovascular disease (n = 18; 42.9%), followed by second primary cancer (SPC) (n = 11; 26.2%). Lung cancer accounted for 54.5% (6 of 11) of SPC associated deaths. Patients with cN0 oral cancer treated with up-front surgery are potentially highly curable for index cancer but face significant risks of mortality from causes other than disease recurrence. Nearly one-third of these patients died from competing causes of death which are major cause of mortality after the fourth year of follow-up period. This study highlights the importance of adjusted follow-up strategies addressing this population specific risks.

Enterococcus faecalis co-cultured with oral cancer cells exhibits higher virulence and promotes cancer cell survival, proliferation, and migration: an in vitro study.

Introduction. Enterococcus faecalis is a common pathogen associated with many oral diseases and is often isolated from oral cancer patients. However, limited information is available on its key virulence gene expression in oral cancer cell microenvironment and cancer cell behaviour in co-culture studies.Hypothesis. E. faecalis overexpresses virulence genes when co-cultured with oral cancer cells and possibly alters the tumour microenvironment, promoting oral cancer proliferation and survival.Aim. To investigate altered virulence gene expression in E. faecalis and oral cancer cell behaviour using in vitro co-culture experiments.Methodology. Cal27 cells were co-cultured with E. faecalis and assessed for their cell proliferation, apoptosis, migration and clonogenicity using standard cell culture assays. The levels of reactive oxygen species (ROS) and inflammatory cytokines, along with proliferative, angiogenic and apoptotic biomarker expressions, were also assessed. E. faecalis adherence to cancer cells was demonstrated by the gentamicin protection assay. Real time-PCR was used to analyse the expression of virulence genes.Results. Co-culture of Cal27 cells with E. faecalis showed significantly higher cell proliferation, migration and clonogenicity compared to the control (P<0.01). A significant increase in the levels of ROS and inflammatory cytokines and overexpression of Ki67, vascular endothelial growth factor, extracellular signal-regulated kinase 1/2, phosphoinositide 3 kinase and Akt was observed in the co-culture group. E. faecalis also downregulated p53 and Bax genes while upregulated Bcl-2. The virulence genes GelE, Asa and Ace were overexpressed in E. faecalis co-cultured with Cal27 cells.Conclusion. The results from this study indicate the possible risks of E. faecalis infection in oral cancer. An effective antibiotic strategy against E. faecalis to prevent complications associated with oral diseases, including cancer, is needed.