High Failure Rates in Young Nonsmoker Nondrinkers With Squamous Cell Carcinoma of the Oral Tongue

Abstract

Objective(s) There has been a disproportionate increase in the incidence of young patients with squamous cell carcinoma of the oral tongue (SCCOT). The purpose of this study was to compare young patients to older patients with SCCOT without prior drinking or smoking history as this population is poorly characterized in the literature. Methods A retrospective review of patients presenting to our institution with SCCOT was performed. The clinical and pathologic characteristics, as well as, outcomes were compared between younger patients (age ≤45) and older patients (age >45). Outcome analysis was performed using Kaplan Meier method. Multivariable Cox proportional hazard models were performed for age and stage. Results Eighty‐two patients (38 young, 44 old) were included in this study. Median follow‐up was 29.4 months. When compared to the older cohort (age >45), the younger cohort (age ≤45) demonstrated lower rates of 5‐year locoregional control (LC) (79.6% vs. 52.5%, p = 0.043) and distant metastasis‐free survival (88.1% vs. 61.8%, p = 0.006). Both cohorts demonstrated similar overall survival rates (55.5% vs. 58.1%) and disease‐specific survival (66.2% vs. 58.1%). Of patients experiencing locoregional failure with available radiation therapy plans and PET scans in younger cohorts (n = 7), 100% demonstrated in‐field failures. Multivariable Cox proportional hazards demonstrated age was an independent predictor of DMFS (p = 0.004) and the advanced stage was a predictor of DSS (p = 0.03). Conclusions Young, nondrinker, nonsmokers with SCCOT demonstrate high rates of locoregional recurrence, distant metastasis, and in‐field failures. Future studies are warranted to determine underlying mechanisms driving pathogenesis in this unique cohort. Level of Evidence 3 Laryngoscope, 133:1110–1121, 2023

Characteristics of oral squamous cell carcinoma focusing on cases unaffected by smoking and drinking: A multicenter retrospective study

“…Furthermore, it has recently been reported that for young patients with tongue cancer, local metastasis, higher tumor grade, and larger tumor size are associated with an increased risk of death in early‐ and late‐stage disease; however, in late‐stage disease, African American race, positive surgical margins, and distant metastasis are associated with poor prognosis 25 . Another recent report comparing young and older patients with tongue cancer found that young patients had higher rates of locoregional recurrence and distant metastasis 26 . There has been a long‐standing controversy and much literature regarding the prognosis of young patients with tongue cancer and its associated factors.…”

“…25 Another recent report comparing young and older patients with tongue cancer found that young patients had higher rates of locoregional recurrence and distant metastasis. 26 There has been a long-standing controversy and much literature regarding the prognosis of young patients with tongue cancer and its associated factors. The results of this study and those of previous reports suggest that prognosis is actually determined by age and many other factors, and it is necessary to consider various factors, such as sex, smoking/drinking status, race, tumor grade, stage, and recurrent metastatic mode, when predicting prognosis.…”

“…The first group consisted of young adult patients who, because of their short exposure periods to smoking and alcohol consumption, appeared to be unaffected by these factors with regard to carcinogenesis, regardless of the degree of smoking or alcohol consumption. 10,11,13,14,19,24 Based on previous studies of tongue cancer, which is the most common oral cancer, [15][16][17]25,26 this young adult group included all patients aged <45 years (<45 y). The other two groups consisted of SDs aged ≥45 years (SD ≥45 y) and NSNDs aged ≥45 years (NSND ≥45 y).…”

Sentinel node‐assisted neck dissection in advanced oral squamous cell carcinoma—A new protocol for staging and treatment

“…[2][3][4][5][6] Despite advances in surgical and oncological treatment the prognosis for OSCC is still relatively unfavorable with a 5-year relative survival of 68%, 7 where younger patients seem to have a worse outcome compared to their older counterparts. 8 Neck metastases (N+) is a strong negative prognostic factor in OSCC. [9][10][11] For patients diagnosed with advanced OSCC, T3-T4 and N+, therapeutic ipsi-lateral neck dissection (TND) is an accepted standard of treatment often followed by radio/chemotherapy.…”

“…OSCC has an increasing incidence, and in contrast to the most head and neck cancers, that incidence is increasing among younger adults without a history of tobacco or alcohol abuse 2–6 . Despite advances in surgical and oncological treatment the prognosis for OSCC is still relatively unfavorable with a 5‐year relative survival of 68%, 7 where younger patients seem to have a worse outcome compared to their older counterparts 8 …”