Squamous cell carcinoma of buccal mucosa: An analysis of prognostic factors

Saurabh Bobdey; Jignasa Sathwara; Aanchal Jain; Sushma Saoba; Ganesh Balasubramaniam

doi:10.4103/sajc.sajc_317_16

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ORIGINAL ARTICLE: Head and Neck Cancer

07 (

); 49-54

doi:

10.4103/sajc.sajc_317_16

Squamous cell carcinoma of buccal mucosa: An analysis of prognostic factors

Saurabh Bobdey^1,, Jignasa Sathwara¹, Aanchal Jain¹, Sushma Saoba¹, Ganesh Balasubramaniam¹

1 Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India

*Corresponding author: Dr. Saurabh Bobdey. sbobdey@yahoo.com

Published: 2020-12-22

MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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Abstract

Introduction: Carcinoma of the buccal mucosa is the most common oral cavity cancer in the Indian subcontinent. The aim of this study was to analyze the outcome and evaluate prognostic factors in surgically treated buccal mucosa squamous cell carcinoma (BMSCC) patients. Materials and Methods: A retrospective study was performed by reviewing the medical records of 409 pathologically proven buccal mucosa cancer patients, who were diagnosed and surgically treated in Tata Memorial Hospital between January 1, 2006, and December 31, 2008. Results: The overall 5-year survival of the cohort was found to be 54.1%. The stage-wise survival rate for tumor, node, metastasis (TNM) Stage I, II, III, and IV patients was found to be 85.2%, 82.9%, 56.3%, and 42.6% (P < 0.00), respectively. On multivariate Cox proportional hazard analysis, the presence of comorbidity, histological tumor size, pathological lymph node status, tumor differentiation, perineural invasion, and extracapsular spread were found to be independently associated with overall survival. Conclusion: BMSCC is an aggressive malignant tumor. In addition to TNM classification, other clinical and pathological factors also have a significant role in BMSCC prognostication. Hence, there is a need to move beyond TNM and develop a more inclusive, flexible, and easy to use prognostic system.

Keywords

References

Ferlay J, Soerjomataram I, Ervik MB. GLOBOCAN 2012: Cancer Incidence, Mortality and Prevalence Worldwide. International Agency for Research on Cancer; 2012. Available from: http://www.globocan.iarc. [Last accessed on 2016 Aug 17].
Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A, et al. Global cancer statistics, 2012. CA Cancer J Clin 2015;65:87-108.
Incidence, Distribution, Trends in Incidence Rates and Projections of Burden of Cancer. In: Three-Year Report of Population Based Cancer Registries 2012-2014. Bengaluru; 2016.
An Assessment of the Burden and Care of Cancer Patients. In: Consolidated Report of Hospital Based Cancer Registries 2012-2014. Bengaluru; 2016.
Srivastava V, Kaur T, Sucharita V. Consences Document for Managment of Buccal Mucosa Cancer. New Delhi: Indian Council of Medical Reserch; 2014.
Agrawal M, Pandey S, Jain S, Maitin S. Oral cancer awareness of the general public in Gorakhpur city, India. Asian Pac J Cancer Prev 2012;13:5195-9.
Singhania V, Jayade BV, Anehosur V, Gopalkrishnan K, Kumar N. Carcinoma of buccal mucosa: A site specific clinical audit. Indian J Cancer 2015;52:605-10.
Sayed SI, Sharma S, Rane P, Vaishampayan S, Talole S, Chaturvedi P, et al. Can metastatic lymph node ratio (LNR) predict survival in oral cavity cancer patients? J Surg Oncol 2013;108:256-63.
Singh AD, von Essen CF. Buccal mucosa cancer in South India. Etiologic and clinical aspects. Am J Roentgenol Radium Ther Nucl Med 1966;96:6-14.
Thiagarajan S, Nair S, Nair D, Chaturvedi P, Kane SV, Agarwal JP, et al. Predictors of prognosis for squamous cell carcinoma of oral tongue. J Surg Oncol 2014;109:639-44.
Urist MM, O'Brien CJ, Soong SJ, Visscher DW, Maddox WA. Squamous cell carcinoma of the buccal mucosa: Analysis of prognostic factors. Am J Surg 1987;154:411-4.
Lu CT, Yen YY, Ho CS, Ko YC, Tsai CC, Hsieh CC, et al. Acase-control study of oral cancer in Changhua County, Taiwan. J Oral Pathol Med 1996;25:245-8.
Chen PC, Kuo C, Pan CC, Chou MY. Risk of oral cancer associated with human papillomavirus infection, betel quid chewing, and cigarette smoking in Taiwan – An integrated molecular and epidemiological study of 58 cases. J Oral Pathol Med 2002;31:317-22.
Singh A, Ladusingh L. Prevalence and determinants of tobacco use in India: Evidence from recent global adult tobacco survey data. PLoS One 2014;9:e114073.
Chockalingam K, Vedhachalam C, Rangasamy S, Sekar G, Adinarayanan S, Swaminathan S, et al. Prevalence of tobacco use in urban, semi urban and rural areas in and around Chennai city, India. PLoS One 2013;8:e76005.
Coelho KR. Challenges of the oral cancer burden in India. J Cancer Epidemiol 2012;2012:701932.
Sankaranarayanan R, Swaminathan R, Brenner H, Chen K, Chia KS, Chen JG, et al. Cancer survival in Africa, Asia, and central America: A population-based study. Lancet Oncol 2010;11:165-73.
Yeole BB, Ramanakumar AV, Sankaranarayanan R. Survival from oral cancer in Mumbai (Bombay), India. Cancer Causes Control 2003;14:945-52.
Iyer SG, Pradhan SA, Pai PS, Patil S. Surgical treatment outcomes of localized squamous carcinoma of buccal mucosa. Head Neck 2004;26:897-902.
Badakh DK, Grover AH. The efficacy of postoperative radiation therapy in patients with carcinoma of the buccal mucosa and lower alveolus with positive surgical margins. Indian J Cancer 2005;42:51-6.
Lubek JE, Dyalram D, Perera EH, Liu X, Ord RA. A retrospective analysis of squamous carcinoma of the buccal mucosa: An aggressive subsite within the oral cavity. J Oral Maxillofac Surg 2013;71:1126-31.
Huang CH, Chu ST, Ger LP, Hou YY, Sun CP. Clinicopathologic evaluation of prognostic factors for squamous cell carcinoma of the buccal mucosa. J Chin Med Assoc 2007;70:164-70.
Pokhrel A, Martikainen P, Pukkala E, Rautalahti M, Seppä K, Hakulinen T, et al. Education, survival and avoidable deaths in cancer patients in Finland. Br J Cancer 2010;103:1109-14.
Fiva JH, Hægeland T, Rønning M, Syse A. Access to treatment and educational inequalities in cancer survival. J Health Econ 2014;36:98-111.
Lee L, Cheung WY, Atkinson E, Krzyzanowska MK. Impact of comorbidity on chemotherapy use and outcomes in solid tumors: A systematic review. J Clin Oncol 2011;29:106-17.
Ribeiro KC, Kowalski LP, Latorre MR. Impact of comorbidity, symptoms, and patients' characteristics on the prognosis of oral carcinomas. Arch Otolaryngol Head Neck Surg 2000;126:1079-85.
de Cássia Braga Ribeiro K, Kowalski LP, Latorre Mdo R. Perioperative complications, comorbidities, and survival in oral or oropharyngeal cancer. Arch Otolaryngol Head Neck Surg 2003;129:219-28.
Oliveira LR, Ribeiro-Silva A, Costa JP, Simões AL, Matteo MA, Zucoloto S, et al. Prognostic factors and survival analysis in a sample of oral squamous cell carcinoma patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:685-95.
Willén R, Nathanson A, Moberger G, Anneroth G. Squamous cell carcinoma of the gingiva. Histological classification and grading of malignancy. Acta Otolaryngol 1975;79:146-54.
Su HH, Chu ST, Hou YY, Chang KP, Chen CJ. Spindle cell carcinoma of the oral cavity and oropharynx: Factors affecting outcome. J Chin Med Assoc 2006;69:478-83.
Liao CT, Wang HM, Ng SH, Yen TC, Lee LY, Hsueh C, et al. Good tumor control and survivals of squamous cell carcinoma of buccal mucosa treated with radical surgery with or without neck dissection in Taiwan. Oral Oncol 2006;42:800-9.
Fagan JJ, Collins B, Barnes L, D'Amico F, Myers EN, Johnson JT, et al. Perineural invasion in squamous cell carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg 1998;124:637-40.
Woolgar JA, Scott J, Vaughan ED, Brown JS, West CR, Rogers S, et al. Survival, metastasis and recurrence of oral cancer in relation to pathological features. Ann R Coll Surg Engl 1995;77:325-31.
Woolgar JA. Histopathological prognosticators in oral and oropharyngeal squamous cell carcinoma. Oral Oncol 2006;42:229-39.
Scholl P, Byers RM, Batsakis JG, Wolf P, Santini H. Microscopic cut-through of cancer in the surgical treatment of squamous carcinoma of the tongue. Prognostic and therapeutic implications. Am J Surg 1986;152:354-60.
Sutton DN, Brown JS, Rogers SN, Vaughan ED, Woolgar JA. The prognostic implications of the surgical margin in oral squamous cell carcinoma. Int J Oral Maxillofac Surg 2003;32:30-4.
Diaz EM Jr., Holsinger FC, Zuniga ER, Roberts DB, Sorensen DM. Squamous cell carcinoma of the buccal mucosa: One institution's experience with 119 previously untreated patients. Head Neck 2003;25:267-73.
Le Tourneau C, Velten M, Jung GM, Bronner G, Flesch H, Borel C, et al. Prognostic indicators for survival in head and neck squamous cell carcinomas: Analysis of a series of 621 cases. Head Neck 2005;27:801-8.
Cerezo L, Millán I, Torre A, Aragón G, Otero J. Prognostic factors for survival and tumor control in cervical lymph node metastases from head and neck cancer. A multivariate study of 492 cases. Cancer 1992;69:1224-34.
Leemans CR, Tiwari R, Nauta JJ, van der Waal I, Snow GB. Regional lymph node involvement and its significance in the development of distant metastases in head and neck carcinoma. Cancer 1993;71:452-6.
Grandi C, Alloisio M, Moglia D, Podrecca S, Sala L, Salvatori P, et al. Prognostic significance of lymphatic spread in head and neck carcinomas: Therapeutic implications. Head Neck Surg 1985;8:67-73.
Woolgar JA, Rogers SN, Lowe D, Brown JS, Vaughan ED. Cervical lymph node metastasis in oral cancer: The importance of even microscopic extracapsular spread. Oral Oncol 2003;39:130-7.
Shingaki S, Takada M, Sasai K, Bibi R, Kobayashi T, Nomura T, et al. Impact of lymph node metastasis on the pattern of failure and survival in oral carcinomas. Am J Surg 2003;185:278-84.
Kalavrezos N, Bhandari R. Current trends and future perspectives in the surgical management of oral cancer. Oral Oncol 2010;46:429-32.
Leite IC, Koifman S. Survival analysis in a sample of oral cancer patients at a reference hospital in Rio de Janeiro, Brazil. Oral Oncol 1998;34:347-52.

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[1] Ferlay J, Soerjomataram I, Ervik MB. GLOBOCAN 2012: Cancer Incidence, Mortality and Prevalence Worldwide. International Agency for Research on Cancer; 2012. Available from: http://www.globocan.iarc. [Last accessed on 2016 Aug 17].

[2] Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A, et al. Global cancer statistics, 2012. CA Cancer J Clin 2015;65:87-108.

[3] Incidence, Distribution, Trends in Incidence Rates and Projections of Burden of Cancer. In: Three-Year Report of Population Based Cancer Registries 2012-2014. Bengaluru; 2016.

[4] An Assessment of the Burden and Care of Cancer Patients. In: Consolidated Report of Hospital Based Cancer Registries 2012-2014. Bengaluru; 2016.

[5] Srivastava V, Kaur T, Sucharita V. Consences Document for Managment of Buccal Mucosa Cancer. New Delhi: Indian Council of Medical Reserch; 2014.

[6] Agrawal M, Pandey S, Jain S, Maitin S. Oral cancer awareness of the general public in Gorakhpur city, India. Asian Pac J Cancer Prev 2012;13:5195-9.

[7] Singhania V, Jayade BV, Anehosur V, Gopalkrishnan K, Kumar N. Carcinoma of buccal mucosa: A site specific clinical audit. Indian J Cancer 2015;52:605-10.

[8] Sayed SI, Sharma S, Rane P, Vaishampayan S, Talole S, Chaturvedi P, et al. Can metastatic lymph node ratio (LNR) predict survival in oral cavity cancer patients? J Surg Oncol 2013;108:256-63.

[9] Singh AD, von Essen CF. Buccal mucosa cancer in South India. Etiologic and clinical aspects. Am J Roentgenol Radium Ther Nucl Med 1966;96:6-14.

[10] Thiagarajan S, Nair S, Nair D, Chaturvedi P, Kane SV, Agarwal JP, et al. Predictors of prognosis for squamous cell carcinoma of oral tongue. J Surg Oncol 2014;109:639-44.

[11] Urist MM, O'Brien CJ, Soong SJ, Visscher DW, Maddox WA. Squamous cell carcinoma of the buccal mucosa: Analysis of prognostic factors. Am J Surg 1987;154:411-4.

[12] Lu CT, Yen YY, Ho CS, Ko YC, Tsai CC, Hsieh CC, et al. Acase-control study of oral cancer in Changhua County, Taiwan. J Oral Pathol Med 1996;25:245-8.

[13] Chen PC, Kuo C, Pan CC, Chou MY. Risk of oral cancer associated with human papillomavirus infection, betel quid chewing, and cigarette smoking in Taiwan – An integrated molecular and epidemiological study of 58 cases. J Oral Pathol Med 2002;31:317-22.

[14] Singh A, Ladusingh L. Prevalence and determinants of tobacco use in India: Evidence from recent global adult tobacco survey data. PLoS One 2014;9:e114073.

[15] Chockalingam K, Vedhachalam C, Rangasamy S, Sekar G, Adinarayanan S, Swaminathan S, et al. Prevalence of tobacco use in urban, semi urban and rural areas in and around Chennai city, India. PLoS One 2013;8:e76005.

[16] Coelho KR. Challenges of the oral cancer burden in India. J Cancer Epidemiol 2012;2012:701932.

[17] Sankaranarayanan R, Swaminathan R, Brenner H, Chen K, Chia KS, Chen JG, et al. Cancer survival in Africa, Asia, and central America: A population-based study. Lancet Oncol 2010;11:165-73.

[18] Yeole BB, Ramanakumar AV, Sankaranarayanan R. Survival from oral cancer in Mumbai (Bombay), India. Cancer Causes Control 2003;14:945-52.

[19] Iyer SG, Pradhan SA, Pai PS, Patil S. Surgical treatment outcomes of localized squamous carcinoma of buccal mucosa. Head Neck 2004;26:897-902.

[20] Badakh DK, Grover AH. The efficacy of postoperative radiation therapy in patients with carcinoma of the buccal mucosa and lower alveolus with positive surgical margins. Indian J Cancer 2005;42:51-6.

[21] Lubek JE, Dyalram D, Perera EH, Liu X, Ord RA. A retrospective analysis of squamous carcinoma of the buccal mucosa: An aggressive subsite within the oral cavity. J Oral Maxillofac Surg 2013;71:1126-31.

[22] Huang CH, Chu ST, Ger LP, Hou YY, Sun CP. Clinicopathologic evaluation of prognostic factors for squamous cell carcinoma of the buccal mucosa. J Chin Med Assoc 2007;70:164-70.

[23] Pokhrel A, Martikainen P, Pukkala E, Rautalahti M, Seppä K, Hakulinen T, et al. Education, survival and avoidable deaths in cancer patients in Finland. Br J Cancer 2010;103:1109-14.

[24] Fiva JH, Hægeland T, Rønning M, Syse A. Access to treatment and educational inequalities in cancer survival. J Health Econ 2014;36:98-111.

[25] Lee L, Cheung WY, Atkinson E, Krzyzanowska MK. Impact of comorbidity on chemotherapy use and outcomes in solid tumors: A systematic review. J Clin Oncol 2011;29:106-17.

[26] Ribeiro KC, Kowalski LP, Latorre MR. Impact of comorbidity, symptoms, and patients' characteristics on the prognosis of oral carcinomas. Arch Otolaryngol Head Neck Surg 2000;126:1079-85.

[27] de Cássia Braga Ribeiro K, Kowalski LP, Latorre Mdo R. Perioperative complications, comorbidities, and survival in oral or oropharyngeal cancer. Arch Otolaryngol Head Neck Surg 2003;129:219-28.

[28] Oliveira LR, Ribeiro-Silva A, Costa JP, Simões AL, Matteo MA, Zucoloto S, et al. Prognostic factors and survival analysis in a sample of oral squamous cell carcinoma patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:685-95.

[29] Willén R, Nathanson A, Moberger G, Anneroth G. Squamous cell carcinoma of the gingiva. Histological classification and grading of malignancy. Acta Otolaryngol 1975;79:146-54.

[30] Su HH, Chu ST, Hou YY, Chang KP, Chen CJ. Spindle cell carcinoma of the oral cavity and oropharynx: Factors affecting outcome. J Chin Med Assoc 2006;69:478-83.

[31] Liao CT, Wang HM, Ng SH, Yen TC, Lee LY, Hsueh C, et al. Good tumor control and survivals of squamous cell carcinoma of buccal mucosa treated with radical surgery with or without neck dissection in Taiwan. Oral Oncol 2006;42:800-9.

[32] Fagan JJ, Collins B, Barnes L, D'Amico F, Myers EN, Johnson JT, et al. Perineural invasion in squamous cell carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg 1998;124:637-40.

[33] Woolgar JA, Scott J, Vaughan ED, Brown JS, West CR, Rogers S, et al. Survival, metastasis and recurrence of oral cancer in relation to pathological features. Ann R Coll Surg Engl 1995;77:325-31.

[34] Woolgar JA. Histopathological prognosticators in oral and oropharyngeal squamous cell carcinoma. Oral Oncol 2006;42:229-39.

[35] Scholl P, Byers RM, Batsakis JG, Wolf P, Santini H. Microscopic cut-through of cancer in the surgical treatment of squamous carcinoma of the tongue. Prognostic and therapeutic implications. Am J Surg 1986;152:354-60.

[36] Sutton DN, Brown JS, Rogers SN, Vaughan ED, Woolgar JA. The prognostic implications of the surgical margin in oral squamous cell carcinoma. Int J Oral Maxillofac Surg 2003;32:30-4.

[37] Diaz EM Jr., Holsinger FC, Zuniga ER, Roberts DB, Sorensen DM. Squamous cell carcinoma of the buccal mucosa: One institution's experience with 119 previously untreated patients. Head Neck 2003;25:267-73.

[38] Le Tourneau C, Velten M, Jung GM, Bronner G, Flesch H, Borel C, et al. Prognostic indicators for survival in head and neck squamous cell carcinomas: Analysis of a series of 621 cases. Head Neck 2005;27:801-8.

[39] Cerezo L, Millán I, Torre A, Aragón G, Otero J. Prognostic factors for survival and tumor control in cervical lymph node metastases from head and neck cancer. A multivariate study of 492 cases. Cancer 1992;69:1224-34.

[40] Leemans CR, Tiwari R, Nauta JJ, van der Waal I, Snow GB. Regional lymph node involvement and its significance in the development of distant metastases in head and neck carcinoma. Cancer 1993;71:452-6.

[41] Grandi C, Alloisio M, Moglia D, Podrecca S, Sala L, Salvatori P, et al. Prognostic significance of lymphatic spread in head and neck carcinomas: Therapeutic implications. Head Neck Surg 1985;8:67-73.

[42] Woolgar JA, Rogers SN, Lowe D, Brown JS, Vaughan ED. Cervical lymph node metastasis in oral cancer: The importance of even microscopic extracapsular spread. Oral Oncol 2003;39:130-7.

[43] Shingaki S, Takada M, Sasai K, Bibi R, Kobayashi T, Nomura T, et al. Impact of lymph node metastasis on the pattern of failure and survival in oral carcinomas. Am J Surg 2003;185:278-84.

[44] Kalavrezos N, Bhandari R. Current trends and future perspectives in the surgical management of oral cancer. Oral Oncol 2010;46:429-32.

[45] Leite IC, Koifman S. Survival analysis in a sample of oral cancer patients at a reference hospital in Rio de Janeiro, Brazil. Oral Oncol 1998;34:347-52.

Squamous cell carcinoma of buccal mucosa: An analysis of prognostic factors

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