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ORIGINAL ARTICLE
Year : 2016  |  Volume : 53  |  Issue : 3  |  Page : 399-401
 

Squamous cell carcinoma of the oral cavity and oropharynx in young adults


Department of Radiation Oncology, VMMC and Safdarjung Hospital, New Delhi, India

Date of Web Publication24-Feb-2017

Correspondence Address:
D Sharma
Department of Radiation Oncology, VMMC and Safdarjung Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.200681

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 » Abstract 

BACKGROUND: Head and neck squamous cell carcinoma (SCC) is a disease of older age group predominately in the sixth and eighth decades of life. The incidence of oral SCC (young age <40 years) varies between 0.4% and 3.9%. There has been increasing trend in younger age group worldwide as well as in India as reported by many studies. AIM: The aim of the present study was to compare the clinicopathological profile, treatment, and outcomes of SCC of oral cavity and oropharyngeal cancer in the young age group of <40 years old. MATERIALS AND METHODS: This retrospective observational study was done by retriving data of selected cohort from 2013 to 2015. Patients were divided into 2 groups: Group 1 (10–30 years) and Group 2 (31–40 years) for comparison. SPSS Version 16 software was used for statistical analysis. RESULTS: Cohort of 217 patients was analyzed. The male:female ratio was 11:1. The most frequent site of primary tumor was tongue > buccal mucosa. The primary site of cancer as oropharynx was present in 3 (5.17%) and 22 (13.83%) patients, respectively, in two groups. Mean overall survival (OS) in two groups was 22.53 and 25.14 months, respectively (P = 0.119). The median disease-free survival (DFS) in two groups was 7 and 8 months, respectively. CONCLUSION: The present study showed that the incidence of oropharyngeal cancer increases with age, but the behavior is more aggressive in a younger age group in spite of aggressive treatment, the DFS and OS were not improved in under 30 years group.


Keywords: Head and neck squamous cell carcinoma, prognosis, young age


How to cite this article:
Sharma D, Singh G. Squamous cell carcinoma of the oral cavity and oropharynx in young adults. Indian J Cancer 2016;53:399-401

How to cite this URL:
Sharma D, Singh G. Squamous cell carcinoma of the oral cavity and oropharynx in young adults. Indian J Cancer [serial online] 2016 [cited 2017 Jun 28];53:399-401. Available from: http://www.indianjcancer.com/text.asp?2016/53/3/399/200681



 » Introduction Top


In the Indian subcontinent, one of the top three types of cancer is oral cancer.[1] Oral cancer is in approximately 30% of all cancers in India. Oral squamous cell carcinoma (SCC) is more common in men between the sixth and eighth decades of life,[2] and the incidence of oral SCC in young age varies between 0.4% and 6.6%.[2]

Prognostic implication of age on the survival of young age is controversial. Numerous studies had shown that the disease was more aggressive with poor prognosis in young adults as compared to older age group.[3],[4] In contrast, Goldenberg et al. have not found any significant difference in survival between different age group.[5]

In the present study, we have compared the outcome of SCC of oral cavity and oropharyngeal cancer in the young age group of <40 years old.


 » Materials and Methods Top


This retrospective study was done in the Department of Radiation Oncology of our hospital and comprised records of all histopathologically proved SCC of oral cavity and oropharynx cancer <40 years of age who were registered in between January 2013 to December 2015. The data were analyzed for each patient included age at the time of diagnosis, gender, addictions, tumor type, clinical and pathological staging, treatment given, recurrences, second primaries and metastasis, time between diagnosis and death or last contact with patient, and possible cause of death.

Patients were divided into two groups according to their ages at diagnosis: Group 1 (10–30 years); Group 2 (31–40 years).

SPSS Version 16 software was used for statistical analysis. The t-test/Mann–Whitney test was applied wherever required to compare the continuous variables. For categorical variables, Chi-square/Fisher's exact test was used. Survival curves were generated using Kaplan–Meier method and survivals compared with log-rank test.


 » Results Top


A total of 1550 patients of head and neck cancer were registered, out of which 290 patients were <40 years of age. A total of 245 patients were diagnosed with carcinoma oral cavity or oropharynx, but 28 patients did not receive any treatment. Therefore, an analysis is done on 217 patients. In the present cohort, the median age was 35 years (range 14–40 years). Out of which, 199 patients (91.7%) were male and 18 patients (8.3%) were female. Youngest male was 14 years old and female was 23 years old. Other clinical characteristics are listed in [Table 1].
Table 1: Characteristics of 217 patients - comparison between two groups

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The most frequent site of tumor location was tongue (48.27% vs. 40.88%) followed by buccal mucosa (36.20% vs. 35.84%) in two groups, respectively.

The primary site of cancer as oropharynx was present in 3 (5.17%) and 22 (13.83%) patients, respectively, in two groups.

Simultaneous use of tobacco chewing/smoking and alcohol consumption was 22.41% versus 34.41%, respectively. In under 30 years group, 31% (18) patients had no history of addiction as compared to 21% (34) patient in above 30 years.

Based on tumor, node, metastasis classification, tumor size “T 4” (n = 108, 49.76%) and absence of regional lymph node metastasis “N0” (n = 95, 43.77%) were more frequently reported. Distant metastasis was absent within the population studied (n = 217, 100%).

Mean overall survival (OS) in two groups was 22.53 and 25.14 months, respectively (P = 0.119) [Figure 1]. The median disease-free survival (DFS) in two groups was 7 and 8 months, respectively. Two-year OS was 50% (median 16 months) and 58% (median not reached), respectively, with a median follow-up of 8 months (range 3–38) and 10 months (range 1–37), respectively. There was no statistically significant difference for OS and DFS between the two groups (P = 0.119 and 0.994, respectively).
Figure 1: Overall survival analysis in patients in two groups

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At the time of last follow-up seventy patients had no evidence of disease, 18 patients had local disease and are live, 35 patients expired due to progression of disease and 94 patients were either lost to follow-up or expired.


 » Discussion Top


This present study describes the clinicopathological characteristics and clinical outcome of patients with carcinoma of oral cavity and oropharynx in young adults (either <30 years or 31–39 years of age).

It has been found that the number of patients is more in the sixth to eighth decade of life,[3] but the trend in younger population is also increasing. In the present study, the ratio of patients involved in two groups is 2.74 which is a bit higher as compared to other study.[6]

In the entire cohort, the male:female ratio is 11:1. However, only one female is in arm I. In arm II, male:female ratio is 8.35:1. This male:female ratio is a bit higher in our study as compared to other studies.[6]

In the present study, oropharynx involvement increases with age. The ratio of involvement of oropharynx in two groups was 1:7.6 this is in concordance with other study.[6]

In the oral cavity, the most common subsite involved was tongue. Other studies had also showed the involvement of tongue as the most frequent site.[1],[2]

Some of the risk factors for adult head and neck SCC (HNSCC) are tobacco chewing, alcoholism, smoking, and human papilloma infection which are usually not present in HNSCC of young patients. Although in recent years, a significant shift has been noticed in lifestyle habits including early exposure to smoking.[7],[8] In the present study, also 31% cases had addiction for tobacco/smoking in above 30 years group as compared to 21% cases in <30 years of age group.

As regards the tumor staging and grading, there was no significant difference between the groups of patients <30 years and those above. T3 and T4 tumors were the predominant stages for both groups and majority were moderately differentiated tumors. Hilly et al. also reported that patients in young age group presented with T3 and T4 tumors and advanced stage.[9]

Many studies have shown that patients in the younger age group have a more aggressive disease with a higher incidence of local recurrence or regional lymph node involvement after treatment compared with older patients.[3],[4] Our comparison of the local recurrence-free survival for the group <30 years and the group above 30 years yielded no significant result (P = 0.940). In the present study, the OS of <30 years of age group was less as compared to more than 30 years group but was not significant. This was consistent with the study by Hilly et al. who demonstrated that there was insignificant difference between the OS and DFS in the younger group as compared to older one.[9] This has been found in the study that in spite of aggressive treatment in younger age group, the OS and DFS were not improved in younger age group.


 » Conclusion Top


Our comparison of younger patients (<30 years) with >30 years of age group revealed that with age, oropharyngeal cancer increases. In spite of more aggressive treatment in <30 years of age group, the DFS and OS were not improved in under 30 years group. Further studies are needed to improve our understanding of the pathogenesis of oral and oropharynx cancer in young patients as there is even less exposure to risk factors such as tobacco.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 » References Top

1.
Elango JK, Gangadharan P, Sumithra S, Kuriakose MA. Trends of head and neck cancers in urban and rural India. Asian Pac J Cancer Prev 2006;7:108-12.  Back to cited text no. 1
    
2.
Sasaki T, Moles DR, Imai Y, Speight PM. Clinico-pathological features of squamous cell carcinoma of the oral cavity in patients <40 years of age. J Oral Pathol Med 2005;34:129-33.  Back to cited text no. 2
    
3.
Amsterdam JT, Strawitz JG. Squamous cell carcinoma of the oral cavity in young adults. J Surg Oncol 1982;19:65-8.  Back to cited text no. 3
    
4.
Sarkaria JN, Harari PM. Oral tongue cancer in young adults less than 40 years of age: Rationale for aggressive therapy. Head Neck 1994;16:107-11.  Back to cited text no. 4
    
5.
Goldenberg D, Brooksby C, Hollenbeak CS. Age as a determinant of outcomes for patients with oral cancer. Oral Oncol 2009;45:e57-61.  Back to cited text no. 5
    
6.
Udeabor SE, Rana M, Wegener G, Gellrich NC, Eckardt AM. Squamous cell carcinoma of the oral cavity and the oropharynx in patients less than 40 years of age: A 20-year analysis. Head Neck Oncol 2012;4:28.  Back to cited text no. 6
    
7.
Hirota SK, Braga FP, Penha SS, Sugaya NN, Migliari DA. Risk factors for oral squamous cell carcinoma in young and older Brazilian patients: A comparative analysis. Med Oral Patol Oral Cir Bucal 2008;13:E227-31.  Back to cited text no. 7
    
8.
Salem A. Dismissing links between HPV and aggressive tongue cancer in young patients. Ann Oncol 2010;21:13-7.  Back to cited text no. 8
    
9.
Hilly O, Shkedy Y, Hod R, Soudry E, Mizrachi A, Hamzany Y, et al. Carcinoma of the oral tongue in patients younger than 30 years: Comparison with patients older than 60 years. Oral Oncol 2013;49:987-90.  Back to cited text no. 9
    


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