Brianna Jones, MD, BS from the Icahn School of Medicine at Mount Sinai discusses ASTRO Abstract 3885 Pathologic Features and Outcomes for Oral Tongue Squamous Cell Carcinoma in Young, Non-Smoker, and Non-Drinker Population.
Link to Poster -
Purpose / Objective(s): The occurrence of young patients with oral tongue squamous cell carcinoma (OTSCC) has been disproportionately increased. Young patients with no past history of smoking or alcohol tend to have a more violent phenotype and a poorer prognosis, although this demographic is not well known. The purpose of this study was to equate young patients with older OTSCC patients without a previous history of drinking or smoking.
Methods/Materials: A retrospective review was conducted on patients submitted to our OTSCC institution between January 2005 and February 2020. Diagnosis of primary OTSCC without a history of alcohol or tobacco use was included in the inclusion criteria. The age threshold of the young cohort was described as 45 years. Data were analyzed for demographic, clinical appearance, care, staging, locoregional failure, distant failure, and survival. Using a regular t-test, chi-square, and Fisher's exact test, statistical analysis was carried out.
Results: 69 patients (52.2 percent young and 47.8 percent old), with mean ages of 37.3 and 61.1 years, met the inclusion criteria for this review. In the older generation, the younger cohort was 63.6 percent male vs 52.8 percent (p=0.47). Both patients were operationally treated. 48 patients (70.0 percent) received adjuvant radiation therapy (RT) and 29 (42.0 percent) received adjuvant chemotherapy without discrepancies between classes in adjuvant care. The median follow-up was 2.4 years in the overall cohort. In older patients, there was a greater proportion of pathologic stage III-IVB (86.1 percent) compared to younger patients (42.4 percent) (p < 0.001). In older patients, the pathologic T stage (0-2 vs 3-4) was significantly higher (p<0.05). The mean tumor size was comparable, but in older patients, the mean invasion depth was higher (1.35 vs 0.71 cm, p < 0.001). In older patients, the number of positive nodes was substantially greater than in younger patients (p<0.05). In older patients 13 (36.1 percent), the lymphovascular invasion was observed at a higher rate relative to young patients 5 (15.2 percent,) (p = 0.059). There was no difference between groups in the incidence of PNI, positive or near margins, ENE, high-grade disease. Overall, relative to the older cohort 9 (25.0 percent) (p < 0.05), the younger cohort had a higher rate of locoregional failure 17 (51.5 percent). In young patients, the rate of distant failure was higher (11, 33.3 percent) compared to old patients (2, 5.6 percent) (p<0.05). The period of survival after completion of treatment was 19.5 months (young) vs 21.8 months (old) (p=0.84). The 2-year survival rate between the two groups was comparable (69.7 percent vs 67.7 percent, p=0.80).
Conclusion: In contrast to older non-smokers, non-drinkers with OTSCC, young non-smokers showed substantially higher rates of locoregional and distant failure. A separate clinical entity appears to serve young patients without conventional risk factors. In order to further improve care and surveillance options for this population, potential research investigating etiology, biological associations, and predictors of bad results is warranted.