Non-smoking, non-drinking elderly females, a five-year follow-up of a clinically distinct cohort of oral squamous cell carcinoma patients

Abstract

Background: The most common flap complication that causes flap failure is mainly due to venous thrombosis. Double venous anastomoses have been advocated in reducing the risk of venous compromise and flap failure. However, this procedure still remains controversial. Objective: The author conducted a cumulative meta-analysis to determine the benefits of double venous anastomoses in head and neck reconstruction. Methods: A literature search was conducted in accordance to the PRISMA checklist. Odds ratio (OR) was used for comparison. Statistical heterogeneity evaluation was performed using I2. If heterogeneity was non-significant, the fixed-effects model was used; otherwise, the random-effects model was used. Results: 24 articles with 6517 flaps were included in this cumulative meta-analysis. In view of venous compromise, single venous anastomoses group had a significant higher incidence compared to the double venous anastomoses (OR = 1.71; 95% CI = 1.19 to 2.45; P = 0.004). In view of flap failure, the single venous anastomoses group also tended to have a higher incidence compared to double venous anastomoses (OR = 1.69; 95% CI = 1.09 to 2.62; P = 0.018). The cumulative meta-analysis effectively demonstrates a significant increase in venous compromise at the single venous anastomoses after adding trials conducted in 2014 onwards, whilst for flap failure the significant increase in single venous anastomoses was identified after adding trials in 2015 onwards. Conclusion: The cumulative meta-analysis supports the evidence that use of two venous anastomoses reduces the incidence of venous compromise and total flap failure in head and neck reconstruction.

“Fact or fiction?”: Oral cavity cancer in nonsmoking, nonalcohol drinking patients as a distinct entity—Scoping review

“…Further, five studies observed that this site predilection tallied with the age distribution. 11,19,20,23,27 Younger NSND patients were found to have anterior tongue carcinomas commonly while more gingivobuccal tumors were often observed among elderly patients. This stratification was even more marked for NSND women than men.…”

“…Three of these studies observed markedly a higher proportion of white patients in the NSND than SD group. 27,30,31,33 The anterior tongue (ICD-10-C02) and gingivobuccal mucosa (ICD-10-C03, C06.0) were the two most common oral cavity subsites for tumor occurrence among NSND patients in most studies 11,19,20,22,23,27,[32][33][34] with a significantly higher proportion of tumors in these anatomic sites than SD patients (Table 2). Further, five studies observed that this site predilection tallied with the age distribution.…”

“…18,22 No difference in the TNM stage distribution was observed between NSND and SD patients in four studies. 11,13,20,23 Eight studies evaluated the differences in tumor grading based on the WHO classification between NSND and SD patients, five of which found comparatively higher proportion of well-differentiated tumors among NSND than SD cases. 3,13,19,30,31,34 Other demographic and clinicopathologic characteristics peculiar to NSND OCSCC patients documented in single reports are further presented in Table 2.…”

Molecular drivers of oral cavity squamous cell carcinoma in non-smoking and non-drinking patients: what do we know so far?

“…10 A meta-analysis of 26 articles with a total of 2532 oral cancer patients (not limited to the oral cavity) found that those with PD-L1 overexpression had lower disease-specific and disease-free survival; these patients also tend-ed to be females, NS, and/or ND. 74 Others have found a higher rate of recurrent/persistent disease and poorer 5-year survival in elderly NSND women vs SD male and female age-matched controls, 23 and proposed that elderly NSND females, 24 or young NSND patients 75 constitute a clinically distinct subset of OCSCC. Interestingly, NSND patients tend to develop malignancies at different histological sites than SD individuals, with more tumors located in the cheek mucosa and alveolar ridge, which also suggests different clinical behavior.…”

“…As such, molecular changes that drive the tumorigenesis in NSND patients remain scarce. Although more recently several studies have attempted to evaluate the clinical characteristics of OCSCC in non-smoking (NS) patients, 10,[23][24][25] the clinicopathologic data regarding the frequency of such tumors and age of tumor onset are conflicting, 10,23,25,26 and relatively few molecular drivers of the progression of OCSCC in NSND patients are currently recognized. In this overview, we summarize the current state of knowledge regarding the clinicopathologic, survival, and molecu-N o n -c o m m e r c i a l u s e o n l y lar characteristics of OCSCC patients without traditional risk factors.…”