Squamous cell carcinoma of the oral tongue in young patients: a matched-pair analysis Ching-Chih Lee Department of Otolaryngology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan E-mail: LCC@tzuchi.com.tw
More and more reports reveal that there is an increased incidence of squamous cell carcinoma (SCC) of the oral tongue, but there is disagreement in the literature concerning the prognosis of young patients.
Some studies showed that prognosis in young patients is better.
McGregor GI et al. Am J Surg 1983;146:88-92.
Clark RM et al. Am J Surg 1982;144:459-62.
Lacy PD et al. Otolaryngol Head Neck Surg
However, some studies note that there are no significant differences in the outcome between the different age groups.
Friedlander PL et al. Head Neck 1998;20:363-8.
Pitman KT et al. Head Neck 2000;22:297-302.
Gilroy JS et al. Head Neck 2005;27:269-73.
Pytynia KB et al. Arch Otolaryngol Head Neck Surg 2004;130:869-73.
We designed a matched-pair analysis between young patients and older patients with SCC of the oral tongue to address the issue of outcome.
Patients and methods(1)
There were 77 patients with newly diagnosed, previously untreated SCC of the oral tongue at our Hospital between 1999 and 2005.
Patients received curative treatment were included.
Exclusion criteria: distant metastasis at presentation, incomplete treatment, loss of follow-up.
Patients under 45 years of age were matched randomly with patients older than 45 years. Matching variables were sex and clinical stage of disease. The final study sample consisted of 40 patients, 20 younger than 45 years (younger group) and 20 older than 45 years (older group) (Table I).
Patients and methods (2)
All tumors were staged according to the American Joint Committee on Cancer (AJCC) system, and all data were analyzed with the SPSS system.
Estimates of survival were computed with the Kaplan-Meier product limit method. The log-rank test was used to determine where endpoints stratified by levels of selected explanatory variables were significantly different.
The primary endpoints of the study were to determine overall survival, disease-specific survival, disease-free survival, locoregional control, and distant metastasis.
The age of the young patients ranged from 27 to 45 years (median 40 years); the age of matched older patients ranged from 46 to 77 years ( median 52 years).
Follow-up time ranged from 7 to 58 months (mean±SD, 24.0±16.8 months; median, 20.5 months) in the young patients and from 6 to 52 months (mean±SD, 22.4±13.0 months; median, 19.0 months) in the older patients.
Results ( 2 )
There were no significant differences between the two populations in terms of sex, tobacco use, alcohol use, and betel nut chewing.
The patients were evenly matched according to stage, tumor, and nodal status (Table I). Although the two groups were not matched according to treatment, the types of treatment used were similar.
Results ( 3 )
Mean survival duration until death from any cause (overall death) was 55±3 months in the younger group and 32±5 months in the older group (p=0.013) (Figure 1).
Mean survival until death from disease was 55±3 months in the younger group and 36±5 months in the older group (p=0.046) (Figure 2).
Mean survival until recurrence was 49±5 months in the younger group and 33±5 months in the older group (p=0.14) (Figure 3).
Results ( 4 )
The local recurrence rate was higher in the older patient population. Five of 20 (25%) older patients had local recurrence, versus 1 of 20 (5%) of the younger patients (p=0.184).
The regional recurrence rate was higher in the older patients. Six of 20 (30%) older patients had regional recurrence in the older group, versus 3 of 20 (15%) in the younger group (p=0.449).
These differences were not statistically significant but demonstrate a trend toward an increased primary recurrence and increased regional recurrence in the older population.
The rates of both local recurrence and regional recurrence were higher in the older patients. Failure at the primary site had a poor prognosis for both groups. All five older patients with local recurrence died of their disease, whereas one of the younger patients with local recurrence died of their disease.
Two of 20 (10%) older patients had distant metastasis and both of them died of disease; however, none of the young patients had distant metastasis. Overall survival and disease-specific survival were better in the younger patient group.
The p53 mutation is less common in tongue cancer in young patients without a history of alcohol and tobacco usage.
The oral and genital mucosa are similar. Herpes simplex virus (HSV) and human papilloma virus (HPV), especially HPV-16 and HPV-18, have been detected in a significant percentage of cervical cancers. The implication of HSV in the development of uterine cervical cancer has prompted investigation of HSV’s role in oral cancer . Hafkamp et al. showed that HPV was more commonly detected in young patients with head and neck cancer and has been related to wild-type p53 expression, pRb down-regulation, and overexpression of p16 INK4A .
Hafkamp et al. Acta Otolaryngol (Stockh) 2004;124:520-6
From the above evidence, we can say that tongue cancer in young patients may represent a different disease.
The major limitation of our study rests with the small sample size; however, we tried to limit the effect of potential confounders by matching pairs, and statistical analysis yields valuable observations.
In this study, we conducted a matched-pair analysis. Young patients with SCC of the oral tongue developed fewer locoregional recurrences. The overall survival and disease-specific survival rate were better in the younger patient population.
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