Oral Carcinoma Patients Research Articles

Study of Complete Surgical Response of Stage III Oral Carcinoma Patients in Comparison to Primary Surgery Versus Neoadjuvant Methotrexate With Surgery.

Objective This study aims to compare the efficacy of neoadjuvant methotrexate therapy followed by surgery versus primary surgical management in patients with stage III oral carcinoma. Methods Thirty patients diagnosed with stage III oral carcinoma were enrolled in this prospective study at a tertiary cancer research center. The patients were divided into two groups: 15 patients received neoadjuvant methotrexate therapy followed by surgery, while 15 underwent primary surgical management. Outcomes were evaluated based on tumor downstaging, surgical margins, postoperative complications, and the requirement for adjuvant radiotherapy. Results Patients in the neoadjuvant methotrexate group demonstrated significant tumor downstaging, allowing for less extensive surgical procedures, with 33.3% (n=5) undergoing wide local excision (WLE) compared to 13.3% (n=2) in the primary surgery group. Negative surgical margins were achieved in 93.33% (n=14) of patients in the neoadjuvant group versus 53.33% (n=8) in the surgical group. Additionally, only 13.3% (n=1) of patients in the neoadjuvant group required postoperative radiotherapy, compared to 53.33% (n=8) in the surgical group. The recurrence rate over a six-month follow-up period was comparable between the two groups. Discussion Neoadjuvant methotrexate therapy resulted in better surgical and oncological outcomes by downstaging the tumor, reducing the extent of surgery, and minimizing the need for postoperative radiotherapy. The findings suggest that methotrexate, as a neoadjuvant agent, is effective in improving patient outcomes with fewer side effects compared to standard cisplatin-based regimens. Conclusion Neoadjuvant methotrexate therapy offers a viable treatment option for stage III oral carcinoma, demonstrating improved oncological and surgical outcomes, including less invasive surgery, higher rates of negative surgical margins, and reduced postoperative radiotherapy requirements. Further research with long-term follow-up is necessary to validate these findings and explore the long-term impact on survival and recurrence rates.

196 Oral Carcinoma patients with positive cervical nodes and Extracapsular Extension: A Real-world data

196 Oral Carcinoma patients with positive cervical nodes and Extracapsular Extension: A Real-world data

Comparison of clinicopathological characteristics of young and old North Indian patients of oral squamous cell carcinoma

IntroductionOral squamous cell carcinoma (OSCC) ranks among the most prevalent epithelial malignancies in the head and neck region. Although it predominantly affects older individuals, there has been a concerning rise in incidence among the younger population in recent years. This study aimed to compare the clinicopathological features of OSCC at our institution distinguishing between young and older age groups. MethodsIn the present retrospective study, histopathologically confirmed cases of OSCC were retrieved and assigned into two groups based on their age. Demographic data along with histopathological parameters were assessed. The data collected were statistically analysed using descriptive analysis, chi-square, kappa and multinomial logistic regression tests. A p-value less than or equal to 0.05 was considered statistically significant. ResultsOf the 707 OSCC patients, 585 were over 40 years old, while 122 were 40 or younger. Both the groups exhibited comparable observations with a high degree of keratinization, moderate nuclear pleomorphism, type 3 pattern of invasion, low tumor budding, high stromal and low intratumoral infiltration of lymphocytes, except lymphoplasmacytic infiltrate which was marked in a higher number of young cases. ConclusionOSCC in young and older individuals exhibited similar clinical as well as histopathological findings. Although the increased incidence of OSCC in the young is a cause of concern, so future multicentric studies with a larger sample size are warranted, to shed more light on the behavior and prognosis of OSCC in the young.

Outcome of Upfront Surgically Resected Patients of Oral Tongue Squamous Cell Carcinoma and Factors Affecting it: Experience from Tertiary Care Facility in North India.

Oral tongue squamous cell carcinoma (OTSCC) is the most aggressive subsite among oral cancers. The poor survival rate has been primarily attributed to high loco-regional recurrence. Two recent developments viz. incorporation depth of invasion (DOI) in American Joint Committee on Cancer (AJCC) TNM 8th edition and elective neck dissection in clinically negative neck have potential to improve survival. We in our study have tried to look at overall survival and factors affecting patients of only OTSCC. 144 patients of OTSCC operated upfront between July 2017 and December 2023 were included in our study. Selective neck dissection was done in all patients with clinically negative neck. T staging was done using both AJCC TNM 7th and 8th edition. Primary objective of the study was to determine the overall survival and factors affecting it. The secondary objectives were to determine the disease-free survival and to look at the effect of forementioned new developments in patients in OTSCC. Mean overall survival and disease-free survival in our study cohort was 48.8 months and 48.3 months respectively in follow up period ranging from 2 months to 75 months. DOI > 10 millimetres and involved margins were factors significantly associated with survival on multivariate analysis. Lymph node metastasis was detected in 32(35.2%) patients out of 91 patients with clinically negative neck and 31(21.6%) of patients were upstaged from T1/T2 in AJCC TNM 7th to T3/T4 according to AJCC TNM 8th edition. The 5-years overall survival of our patients was about 54% with nearly half of our patients presenting in stage III and stage IV. There is need to create awareness in general population as the impact of the new changes will only be seen if patients present at an early stage.

Fractionated irradiation induces radioresistant oral carcinoma cells with enhanced malignant phenotypes

ObjectiveThe fact that certain oral carcinoma patients experience radiotherapy failure implies that a more radioresistant and aggressive phenotype of surviving cancer cells potentially occurs during treatment. Our study aimed to establish radioresistant oral cancer cells through a fractionated irradiation protocol that mimics clinically relevant radiotherapy dosing strategies and to investigate all-round alterations in the malignant phenotype. MethodsRadioresistant oral carcinoma cells were generated by exposing Cal27 and Detroit 562 cells to 60 Gy radiation in 10 dose-escalating fractions and verified by cell immunofluorescence. Specific markers related to the epithelial–mesenchymal transition (EMT) process and the cancer stem cell (CSC) phenotype were assessed by Western blotting. Cell invasion and migration were evaluated using Matrigel-coated transwell and wound healing assays, respectively. Nontargeted metabolomics was used to mechanistically delineate the potential metabolic patterns linked to EMT and CSCs; the CSC phenotype was also examined by sphere formation assays and cell immunofluorescence. ResultsRadioresistant oral carcinoma cell lines were successfully established and validated. These cells exhibited enhanced EMT and increase in both cell invasion and migration. These radioresistant cells further demonstrated a high metabolic profile, notably marked by lipid metabolism reprogramming and functional enrichment of ATP-binding cassette (ABC) transporters. Consistently, enhanced CSC phenotype in radioresistant cells was confirmed by elevated expression of stemness markers and increased sphere-forming capacity. ConclusionRadioresistant oral carcinoma cells subjected to fractionated radiation exhibit an augmented malignant phenotype. The metabolic characteristics linked to enhanced EMT and CSC phenotypes provide potential targets for improving radiotherapy in oral carcinoma.

Infrahyoid Myocutaneous Flap for Reconstruction in Head and Neck Cancer Patients

Objective: Oral cancers are one of the most common cancers in India. Tongue and lower gingiva-buccal sulcus are the most common subsites in oral cancers. Good reconstruction after resection of primary is a demanding task and determines quality of life. This study reviews our experience with infrahyoid flap (IHF) in reconstruction of small and medium sized defects after oral cancer resection. Materials and Methods: This study retrospectively analyzes all patients of oral cavity squamous cell carcinoma who underwent IHF flap by a single surgeon from July 2018 till June 2022 with a median follow‑up of 12 months. Results were analyzed based on characteristics of the patients, site and size of defect, postoperative complications and clinical outcome. Results: Out of 14 patients, 4 patients had skin paddle necrosis (2 total and 2 partial). None of the patient suffered a total flap loss. All cases of partial flap loss resolved with conservative treatment and none of the patient required a revision surgery or developed orocutaneous fistula. The largest flap size was 9 × 4.5 cm. Conclusion: The infrahyoid myocutaneous flap is a fairly reliable and easy to perform flap for small and medium‑sized defects of the oral cavity.

Risk Factors of Oral Carcinoma in a Tertiary Level Hospital in Bangladesh

Background: Cancer continues to be a major health problem despite advances in medical technology for its diagnosis and treatment. Oral cancer is the eighth most common cancer in the world. Oral cancer is a multifactorial disease- smoking, betel-nut and betel-leaf chewing habit, bad oral hygiene, and drinking alcohol are the most important factors associated with oral cancer Objectives: To identify the risk factors of oral cancer in a tertiary level hospital in Bangladesh. Methods: A total of 52 patients, aged between fifth to seventh decades, were included in this observational type of cross-sectional study. The study was conducted over the period of six months, from March to August, 2016, in the department of ENT & Head Neck surgery in Dhaka Medical College Hospital, Dhaka. Patients were randomly assigned to one of three groups by card sampling. Results: Among the 52 patients with oral cavity carcinoma, 30(57.69%) were males and 22(42.31%) females. Most patients were from rural areas (30, 57.69%), including agricultural workers 17(32.69%), daily labourers (5, 9.62%), fishermen (3, 5.77%) and others (5, 9.62%). High-risk habits were prevalent among the cases, with 24(46.14%) engaged in Pan (betel leaf) chewing and 15(28.85%) in smoking. Clinical features included ulceration, neck lump, pain, swelling, dysphagia, and bleeding. The most affected areas were buccal mucosa (19, 36.54%) and oral tongue (14, 26.92%). Histopathologically, 27(42.31%) were well-differentiated, 22(51.92%) moderately differentiated, and 3(5.77%) poorly differentiated squamous cell carcinoma. The study provides insights into the demographics and characteristics of oral cavity carcinoma patients. Conclusion: Personal habits like pan, betel-nut, tobacco chewing, ignorance, lack of proper education of oral hygiene, lack of medical facilities and poor referral system are the common factors for aggressiveness of the disease. Journal of Monno Medical College, June 2023; 9 (1): 11-14

Abstract PO-031: Integrated bioinformatics and functional spatial analysis platform for the discovery of predictive biomarkers in oral cancer

Abstract Background: Oral cavity squamous cell carcinoma (OCSCC) has an unpredictable response to immunotherapy, and standard biomarkers evaluating the tumor immune microenvironment (TIME) lack widespread translational applicability. Defining the TIME is critical to understanding mechanisms and allows the development of reproducible and accurate prognostic and predictive biomarkers based on immune profiles; however, to date, this remains elusive for clinical use. To further study and deconstruct the TIME within OCSCC, we integrated our previously developed computational spatial analysis (CSA) with in-silico deconvolution analyses to comprehensively study the TIME in OCSCC. Methods: We leveraged access to two independent OCSCC cohorts (UM and TCGA) with paired bulk RNASeq, WES, and CSA-immune score data. TMB, neoantigen load, and deconvolution analysis (CIBERSORTx) were performed to generate in silico immune profiles. A previously described CSA evaluates the density and distribution of tumor-infiltrating lymphocytes (TILs) relative to cancer cells to generate immune scores (GCross function [GFx]). GFx scores were then correlated with WES and RNASeq-derived cell-type deconvolution results, immune cell activation expression signatures, and gene expression-based radiosensitivity index scores. Pearson's correlation coefficient and associated p-value were calculated for each comparison. Cox proportional hazards multivariate regression was performed using the entire cohort for survival and recurrence analysis. Results: Here, we better characterize the immunologic tumor environment by objectively measuring the TIL density in spatial relationships with cancer cells. We found that immunoreactive tumors with high GFx scores are highly prognostic for overall survival, with the lowest tiers associated with poor survival. Combining the spatial relationship with immunogenomics (WES and RNASeq immune profiles) increased the prognostic capability of the integrated bioinformatics analysis model. In addition, we further revealed that lymphocyte-infiltrated regions, specifically CD8+ T-cells, are associated with TMB, neoantigen load, and improved overall survival. Conclusion: This study provides an integrated dataset from which to generate future insights and possible immunomodulatory therapies to counteract the poor immunogenicity of OCSCC. We show that integrating computational spatial analysis and in-silico deconvolution analysis is generalizable to multiple patient populations with different demographic compositions and pathology images collected from distinctive digitization methods. Our machine-learning approaches provide clinically actionable predictions that confirm the relevance of these biomarkers with immune cell infiltration and suggest the role of digital pathology profiling in predicting response to immunotherapy which could inform treatments for oral squamous carcinoma patients. Citation Format: Michael M. Allevato, Lisa Chionis, Joshua Smith, Santhoshi Krishnan, Leanne Henry, Tingting Qin, Janice Farlow, Laura Rozek, Jonathan Mchugh, Arvind Rao, Maureen Sartor, Steven B. Chinn. Integrated bioinformatics and functional spatial analysis platform for the discovery of predictive biomarkers in oral cancer [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Innovating through Basic, Clinical, and Translational Research; 2023 Jul 7-8; Montreal, QC, Canada. Philadelphia (PA): AACR; Clin Cancer Res 2023;29(18_Suppl):Abstract nr PO-031.

A Retrospective 2-D and 3-D Radiographic analysis of Osseous Changes in Oral Squamous Carcinoma

Aim: To evaluate the 2D and 3D radiographic features of oral squamous cell carcinoma involving jaws for understanding the pattern of bone involvement, for an improved treatment plan. Materials and Methods: Thirty histologically diagnosed patients of oral squamous cell carcinoma were included in the study and the detailed analysis of Orthopantogram (OPG), Computed Tomography (CT)/Cone Beam Computed Tomography (CBCT) / Magnetic Resonance Imaging (MRI) was undertaken. Lesions borders, surrounding and internal structures were evaluated. Results: 2D images aid in identifying the location of the lesion while 3D images help in defining the extension of the lesion. 2D images result in overdiagnosis of extent while 3D images provide an accurate diagnosis of the structures involved. Conclusions: Early screening of the lesion can be done by OPG while CBCT/CT/MRI should be considered as a confirmatory tool to see the extent of disease and for guidance in surgical planning.

Identification of copy number alternation profiles in metastatic oral squamous carcinoma patients by using microarray-based comparative genomic hybridization: A study on Turkish patients

ObjectiveOral squamous cell carcinoma (OSCC) is a severe form of cancer affecting different anatomic sites of the oral cavity. OSCC ranks as the sixth most common cancer type with an increasing prevalence globally. However, the mechanisms of OSCC process at later stages are not well understood. In this study, we aimed to determine genetic alternations in metastatic OSCC patients to identify genomic changes occurred at metastatic phase of the disease. Material and MethodsThe Illumina CytoSNP-12 Array was used to determine copy number variations in OSCC cancer genome. Hybridization procedures were performed according to the manufacturer procedures (Illumina). Arrays were scanned on iScan System (Illumina). Data were analyzed using Illumina Genotyping module of Genome Studio software (version 1.2, Illumina). Multiple CNV algorithms and copy number alternations were accessed by Genome Studio. CNVs in whole genome were investigated by using a chromosomal heat map. ResultsWe reported that gains in 8q21.11-ter, 9p21.3, 13q14.11-ter, 13q13.3-ter and losses in 5q14.3-ter, 5q35 and 17p13.3–12 were associated with the development of OSCC. In addition, we also detected that deletion in 2q33.2-ter and 2q35–37.3 regions were also associated with OSCC metastasis process. ConclusionsOur results were also showed that gains in 11q13.3-q13.4 and 2q13.2 chromosomal regions could promote the metastatic OSCC process. We believe that results of the study will help to find new biomarkers for diagnosis at later stage of OSCC.

Proposal of a secure and efficient protocol for a murine oral carcinogenesis model induced by 4-nitroquinoline-1-oxide (4NQO)

An important rat model using the chemical carcinogen 4-nitroquinoline-1-oxide (4NQO) has been described for the study of the process of oral carcinogenesis. This model replicates the gradual progression seen in oral carcinoma patients. However, due to its high level of toxicity, its use in fundamental research is challenging. Here, we propose a secure and efficient modified protocol based on a lower dose of 4NQO concentration as well as an increased water supply and hypercaloric diet, in order to reduce the damage caused to the animals during the process of oral carcinogenesis. Twenty-two male Wistar rats were exposed to 4NQO, evaluated clinically once a week and euthanized at 12 and 20 weeks for histopathological analysis. The protocol involves a staggered dose of 4NQO up to a concentration of 25 ppm, associated with two days of pure water, a 5% glucose solution once a week and a hypercaloric diet. This modified protocol prevents the immediate consequences of the carcinogen. At week 7, all animals displayed clinically evident tongue lesions. From a histological perspective, after 12 weeks of 4NQO exposure, 72.7% of the animals developed epithelial dysplasia and 27.3% developed in situ carcinoma. In the group exposed for 20 weeks, epithelial dysplasia and in situ carcinoma were diagnosed in one case each, whereas invasive carcinoma was diagnosed in 81.8% of the cases. Nonsignificant modification of animal’s behavior and weight was observed. This new proposed 4NQO protocol was secure and effective for studying oral carcinogenesis and can be used to conduct lengthy investigations.

Palliative Management of Unresectable Oral Carcinoma in Geriatric patients by Laser Ablation and Radiotherapy

INTRODUCTION: Oral carcinoma in Geriatric age group presents a challenge in terms of Morbidity and Mortality. There are challenges in form of Age related illnesses and ability of the oncologist to administer surgery and chemotherapy. Most patients have a bad prognosis due to above factors. This study was carried out in 10 patients over a 4-year period in patients aged 65 and above. PATIENTS AND METHODS: Laser ablation was offered as an alternative to patients not fit or willing for a long duration surgery. Diode laser was used under sonography control for the procedure in all patients. Multiple small sessions were used to control the growth of tumor. Post procedure various adjuvant modalities were used depending on patient acceptance which are enumerated in the study. RESULTS: .All patients had a very good pain relief and freedom from tumor swelling .Most patients had an Overall Survival increase from 8 months to 2 yrs. There was no on table mortality. The overall ablation time was under 1 hour in most patients. Quality Index measurements showed as satisfactory score. The OS was largely dependent on overall health status of the patient and size of tumor. CONCLUSION: Laser ablation for geriatric patients of oral carcinoma is a viable alternative procedure for palliation and overall survival increase. It gives a better quality of life and it is a safer procedure for palliation than a full scale surgery in Geriatric stage 4 inoperable patients.

Prognostic and clinicopathological significance of prognostic nutritional index (PNI) in patients with oral cancer: a meta-analysis.

Accumulating literature has explored how prognostically significant the prognostic nutritional index (PNI) was for the oral carcinoma population, but with inconsistent findings. Therefore, we retrieved the most recent data and carried out this meta-analysis to comprehensively analyze the prognostic performance of pretreatment PNI in oral cancer. The electronic databases of PubMed, Embase, China National Knowledge Infrastructure (CNKI), Cochrane Library and Web of Science were fully retrieved. PNI's prognostic value for survival outcomes in oral carcinoma was assessed by estimating pooled hazard ratios (HRs) plus 95% confidence intervals (CIs). We examined the correlation of PNI with clinicopathological traits of oral carcinoma by utilizing the pooled odds ratios (ORs) plus 95% CIs. According to the pooled results of the present meta-analysis, which enrolled 10 studies involving 3,130 patients, for oral carcinoma suffers whose PNI was low, their disease-free survival (DFS) (HR=1.92, 95%CI=1.53-2.42, p<0.001) and overall survival (OS) (HR=2.44, 95%CI=1.45-4.12, p=0.001) would be inferior. Nonetheless, cancer-specific survival (CSS) was not linked significantly to PNI for the oral carcinoma population (HR=1.89, 95%CI=0.61-5.84, p=0.267). Significant associations of low PNI with TNM stages III-IV (OR=2.16, 95%CI=1.60-2.91, p<0.001) and age ≥ 65 years (OR=2.29, 95%CI=1.76-2.98, p<0.001) were found. As suggested by the present meta-analysis, a low PNI was linked to inferior DFS and OS among oral carcinoma patients. Oral cancer patients with low PNI may have high-risk of tumor progression. PNI could be served as a promising and effective index to predict prognosis in patients with oral cancer.

Assessment of Palmar Patterns and Dermatoglyphics in Oral Cancer Patients of Bareilly City: An Observational Study

Background and objectives: Dermatoglyphics are the dermal ridge configuration on the digits, palms and soles. Dermatoglyphics may be used as an easily accessible tool in the study of genetically induced diseases as genetic or chromosomal defects may be expressed as alterations in dermal ridges. They are genetically determined and influenced by environmental forces that are operating before birth. Several studies have shown an association between dermatoglyphics and different types of cancer. Hence this study was undertaken to determine whether specific dermatoglyphic patterns exist that help in predicting the occurrence of oral squamous cell carcinoma.&#x0D; Aim: This study was conducted to study palmar and dermatoglyphic patterns in oral carcinomas patients in Bareilly city.&#x0D; Material and method: Our study was conducted among 59 subjects having oral cancer in Bareilly city. A modified case history proforma and comprehensive history was taken. Finger and palm prints were collected from Oral squamous cell carcinoma (OSCC) patients using the digital method and were evaluated qualitatively and quantitatively using an appropriate statistical test.&#x0D; Results: Finger and palm prints were evaluated qualitatively and quantitatively. Significant findings in patients with oral squamous cell carcinoma in both hands were: Increased frequency of Loops and whorls, Loop patterns are common in Thenar/I1 area, Increased Total finger ridge count on the right hand, increased ab count on the left hand, more atd angle on the left hand.&#x0D; Conclusion: Our study concluded that dermatoglyphic patterns may have a role in identifying individuals either with or at risk for developing oral squamous cell carcinoma. It can be used to identify high-risk group so that early primary and secondary preventive measures can be instituted to prevent the occurrence of these lesions.

Intra-operative intaoral ultrasonograpy ensures free deep resection margins in carcinoma tongue: A pilot study.

Resection of primary in carcinoma tongue is challenging as the tumor often spreads submucosal and deep in muscles. There are various Intraoperative tools available to guide tumor resection margins. We studied the use of intraoperative ultrasound-guided resection for obtaining free deep resection margins in cases of oral carcinoma tongue. To assess the feasibility of resection of tongue tumor using intraoral ultrasound intraoperatively. 5 patients of oral tongue squamous cell carcinoma were included in this prospective pilot study. Intraoral ultrasound-guided resection of the primary tongue tumor was done. The surgeon moved the probe over the tumor and focussed on the point of maximum invasion by the tumor. A 26 G needle was passed in the tongue at a point that was 10 mm away from the deepest point of infiltration. It marked the deepest plane of resection. Following the above marking, a resection of tumor was done. Deep surgical resection margin was found to be >5 mm (free) in all the USG-guided surgically resected primary tongue tumors on histopathological examination. We have found intraoperative ultrasonography a useful tool for the surgical resection of primary tongue tumours.

Association of tobacco exposure with demographic and clinicopathological factors in patients of oral squamous cell carcinoma - A single-center experience.

Almost a third of the global load of oral squamous cell carcinoma (OSCC) occurs in India and can be attributed to the widespread use of tobacco and tobacco-related products in this part of the sub-continent. Records of 274 patients of OSCC treated between January 2018 and December 2019 in our institute were analyzed for the study for history of tobacco abuse and distribution of associated demographic, clinical, and pathological factors. The age of the patients in the study ranged from 31 to 82 years with a median age of 60 years. The ratio of oral cancer in males: females was 3:1. Exposure to tobacco was seen in the majority of patients (89%) who reported with oral carcinoma. Smokeless tobacco in the form of gutka was the most common abused tobacco, followed by bidi in our study. Tongue and buccal mucosa (38% and 36%, respectively) were the most common sites. Significant statistical correlation of tobacco use was seen with age, gender, clinical, and pathological tumor stages. With tobacco being the main cause of OSCC, further studies with a larger number of patients and preferably with a comparison arm of non-tobacco OSCC would help in elucidating the exact clinical and statistical correlation of tobacco with the clinicopathological factors.

Correlation of serum trace elements (Fe, Cu, and Zn) in the blood samples of Indian patients with leukoplakia, oral squamous cell carcinoma, and normal subjects.

Trace elements (iron, copper, and zinc), leukoplakia, and oral squamous cell carcinoma. To study and correlate serum trace element (iron, copper, and zinc) levels in leukoplakia, oral squamous cell carcinoma, and normal subjects. The present study comprised a total of 80 patients, which included 30 patients of leukoplakia, 30 patients of oral squamous cell carcinoma, and the normal control group comprising 20 healthy individuals who were not having any relevant medical, dental, and habit history. Peripheral blood samples of a volume of 10 ml each will be collected by anti-cubical vein puncture from control groups and from patients suffering from leukoplakia and oral squamous cell carcinoma. The blood will be collected in a plain red top vein puncture tube without additives or anti-coagulants and allowed to stand undisturbed to clot at room temperature, and serum will be separated from the cells by centrifugation at 4°C at a speed of 3000 rev/min, the separated sera will be kept at -20°C until analysis is performed. The estimation of serum zinc (Zn) and copper (Cu) levels is performed by atomic absorption spectrometry (AAS). In the present study, the estimation of copper and zinc levels was conducted by using an atomic absorption spectrophotometer (model no: AA-6300 SHIMADZU, Japan). Serum iron estimation is performed using the kit RANDOX (siedel, 1984). Statistical analysis is performed by the paired and Scheffe tests. From the results, it was concluded that there was a decrease in serum iron and zinc levels and copper had increased serum levels. It was concluded that evaluation of serum trace elements can be a cost-effective and non-invasive alternative for screening, diagnosis, and monitoring of pre-malignant lesions such as leukoplakia and malignant lesions such as oral squamous cell carcinoma. Thus, these parameters can be used as biomarkers that provide important tools in formulating an adequate diagnosis, treatment plan, and prognosis for oral squamous cell carcinoma.

STUDY TO EVALUATE CLINICOPATHOLOGICALASSOCIATION BETWEEN DEPTH OF INVASION AND NECK NODE METASTASIS IN ORAL CAVITY CARCINOMA

Objective: To evaluate association between depth of invasion and neck node metastasis. Methods:Aprospective observational study was carried at Department of ENT, Sawai Man Singh Medical College over a period of one year in which 102 patients of oral carcinoma were included that underwent wide local excision with neck dissection. Results:The mean depth of invasion was 10.59 with 7.44 standard deviation (range 2-45 mm). Lymph node metastasis was present in 3 out of 27 patients with a DOI &lt; 5mm (11%), in 13 out of 39 with a DOI 5.1-10 mm (34%) and in 8 out of 36 with DOI &gt;10mm (22%). Chi square value was 30.79 and the p-value was&lt;0.001. Conclusion: The risk of lymph node metastasis increased with increased depth of invasion.

Role of Indocyanine Green in Mapping Sentinel Cervical Lymph Node Involvement in Patients of Oral Squamous Cell Carcinoma - Preliminary Data from a University Hospital

Introduction: Lymph node (LN) positivity is an important determinant in a patient of oral SCC. Sentinel lymph node (SLN) biopsy may aid in minimizing the extent of elective neck dissection (ND). ICG dye facilitates the visualization of lymphatic vessels, sentinel nodes, and provide high penetration during surgery. Methods: It is a prospective observational study in 2021-2022. N = 32 patients of oral SCC were injected with 1mL of ICG submucosally in 4 quadrant fashion (3,6,9 and 12 o’clock). After elevation of platysma flap and posterior retraction of sternocleidomastoid muscle (15 minutes after injecting ICG), fluorescing LNs were detected using NIR (Near Infra-red) fluorescence imaging (STRYKER AIM 1588 camera system) and were sent for frozen section and histopathological examination (HPE). Results: Majority were carcinoma buccal mucosa (53%), followed by tongue (22%) and GB sulcus (12.5%). Most common method of ND was modified radical ND 78%, followed by supraomohyoid 12.5%, extended supraomohyoid 6.25%, radical ND 3.1%. A total of 755 LNs were harvested. 82 lymph nodes were identified as SLN using ICG method. Level Ib was identified as SLN in 26/32 of the cases, followed by level Ia and level IIa (3/32 cases each). 22 out of 82 SLN were positive in frozen section and HPE respectively with a sensitivity of 100%, specificity of 91.8% and NPV (negative predictive value) of 100 %. Routine pathology demonstrated occult metastasis exclusively in SLN in 10 cases (31.25%). Conclusion: NIR using ICG is a feasible and promising method for SLN biopsy in cN0 oral SCC.

Incidence and impact of skip metastasis in the neck in early oral cancer: Reality or a myth?

ObjectivesVarying evidence exists surrounding skip metastasis in clinically node-negative oral cancer. We aim to report its incidence, identify factors predicting its presence, and determine survival outcomes to possibly decide “adequacy” of neck dissection for this select group. MethodsA review of audit records (clinical and pathologic) was undertaken to identify early stage (cT1/T2 cN0) oral squamous carcinoma patients operated between January 2016 and December 2020. Skip metastasis was defined as presence of nodal metastases distant from the primary tumour and at a lower level without metastases at levels above this. The factors predicting its presence were determined using chi-square and multivariate tests. Survival analysis was performed using Kaplan-Meier and regression hazard models. ResultsOccult metastasis rate was 17.9 % among 761 patients, with 47.1 % travelling to level I. Skip metastasis at level III was seen in 1.2 % and level IV was 0.3 %. Presence of PNI predicted the presence of skip metastasis at level III (p = 0.041, OR-0.241, 95 %CI 0.062–0.942) and no significant factors were identified for level IV. The 5-year disease-free survival was significantly reduced with isolated level IV metastasis (50 % vs 79.6 %, p = 0.017). Isolated occult metastasis at level Ia was in 0.3 %, all from tongue cancers. Their presence did not impact the 5-year overall survival (100 % vs 90.7 %, p = 0.628) and disease-specific survival (100 % vs 92.5 %, p = 0.675). ConclusionThe negligible incidence of skip metastasis to level IV in a clinically node negative neck suggests that clearance up to level III might be adequate in a large majority of patients.