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O21. Oral submucous fibrosis—A clinico-histopathological comparative study in population of southern Rajasthan, India
Abstracts / Oral Oncology 47 (2011) S28–S73
O20. Current practice in the management of the neck after chemo-radiotherapy in patients with locally advanced oro-pharyngeal SCC B. Bisase *, C. Skilbeck, C. Kerawala, C. Spencer Royal Marsden Hospital, UK Introduction: Patients who have a complete neck response to chemo-radiation (CRT) are unlikely to have residual viable tumour, thus questioning the need for planned neck dissection. Partial responders often need further assessment. PETCT is becoming the standard tool to assess primary site and neck disease response to CRT. There is ongoing debate about the timing of assessment, the best imaging technique and the extent of neck dissection (ND) with emerging evidence supporting more selective procedures with attendant decreases in morbidity. Whilst various trials strive to address these controversies, we hypothesise that current practices vary in the United Kingdom (UK). It was therefore the aim of this study to establish the current practice by head/ neck surgeons and oncologists. Methods: Three hundred questionnaires were disseminated to head/neck surgeons and oncologists. Information obtained included the respondents’ background, their preferred choice and timing of investigations, and the type of ND if indicated. Results: Responses revealed a noticeable variation in practice. There was a tendency toward personal choice rather than a multidisciplinary driven approach which itself may reflect an absence of guidelines and paucity of evidence-base. Although there was some agreement in the choice of ND, disparity remained regarding the timing of imaging and surgery. Conclusion: There is inconsistency in the management the neck in this patient cohort in the UK at present with a need to unify practice in order to improve patient care. This study exemplifies the need for long awaited results from current trials on this topic. doi:10.1016/j.oraloncology.2011.06.131
O21. Oral submucous fibrosis—A clinico-histopathological comparative study in population of southern Rajasthan, India J. Ahmed *, S. Goyal Manipal College of Dental Sciences, India Introduction: Oral submucous fibrosis (OSMF) is a precancerous condition associated with the use of betel/areca nut in various forms. This debilitating condition is seen as an insidious chronic disease affecting any part of the oral cavity and some times the pharynx. Although occasionally preceded by and/or associated with vesicle formation, it is always associated with a juxta-epithelial inflammatory reaction followed by a fibro elastic change of the lamina propria. It is characterized by restricted mouth opening, tongue protrusion and cheek rigidity.The relative risk for malignant transformation of this condition is quite high. Method: A hospital-based study was conducted on 100 OSMF cases to correlate the clinical staging with histopathological grading. A detailed history of each patient was recorded along with thorough clinical examination. Punch biopsy was performed for histopathological evaluation. Clinical staging of the disease in terms of the ability to open one’s mouth was correlated with histopathological grading. Results: In the present study, the age of the patient ranged from 20 to 50 years with a peak incidence from 21 to 29 years of age. The male to female ratio of OSMF cases was 5:1. All forms of Areca nut products were associated with OSMF. Chewing of panmasala was associated with early presentation of OSMF as compared to chewing of other products of Areca nut, although the total duration of the
S35
chewing habit was not significantly correlated to OSMF. It was also found that the patients who used panmasala with a greater frequency/day developed OSMF with a shorter duration of the habit. The maximum number of patients affected with OSMF were in clinical stage II and histopathological grade II. Discussion: In the present study, statistical analysis showed that there is no significant correlation between clinical staging and histopathological grading. Significant and direct correlation to the manifestation of OSMF was seen with frequency rather than duration of chewing. Although various degrees of epithelial dysplasia were observed, malignant transformation was not seen. A better understanding of the clinico-histopathological correlation can provide to be a good marker for the diagnosis, prognosis and severity of this multifactorial crippling disease. doi:10.1016/j.oraloncology.2011.06.132
O22. Identification of molecular markers for sentinel lymph node biopsy of oral squamous cell carcinoma R. Oka *, K. Nakashiro, H. Goda, Y. Nishikawa, H. Tanaka, H. Hamakawa Department of Oral and Maxillofacial Surgery, Ehime University Graduate School of Medicine, Japan Cervical lymph node metastasis is a potent prognostic factor in oral squamous cell carcinoma (OSCC). Management of the cN0 neck in OSCC is an important issue for the surgeons. Sentinel lymph node biopsy (SLNB) has received considerable attention for its role in deciding whether to perform neck dissection. We have performed the SLNB for cN0 cases routinely and reported the clinical usefulness. Accurate diagnosis of the metastasis in sentinel lymph nodes is important but depends on a heavy workload of the pathologist. We carried out a clinical study to evaluate a new automated assay system for cytokeratin 19 (CK19) mRNA, the one-step nucleic acid amplification (OSNA) method, to detect the lymph node metastasis of OSCC. The accuracy of OSNA was nearly 95%, but it could not detect in the case of no or low expression of CK19 mRNA in the primary tumor. In this study, we have attempted to identify novel molecular markers to find the harboring cancer cells in the lymph node. First, we determined the gene expression profiles in 7 metastatic lymph nodes from patients with OSCC, 1 normal lymph node, and 5 salivary gland tissues from non-cancerous patients by microarray analysis. We found the overexpression of 36 genes in all metastatic lymph nodes. Subsequently, we examined the expression of these genes in newly 13 metastatic lymph nodes and 7 normal lymph nodes by real-time quantitative RT-PCR method. Among the 36 genes, annexin A8-like 2 (ANXA8L2) and desmoglein 3 (DSG3) were commonly detected in metastatic lymph nodes at a much higher level but not in normal lymph nodes at all. Furthermore, we confirmed the expression of these genes in all of 34 metastatic lymph nodes including 8 false negative lymph nodes by OSNA. These results suggested that ANXA8L2 and DSG3 could be useful markers for detecting sentinel lymph node metastasis of OSCC. doi:10.1016/j.oraloncology.2011.06.133
O23. Evaluation of survivin as a prognostic marker in oral squamous cell carcinoma J.-Y. Yoon *, J.-H. Lee, H. Myoung, S.-M. Kim, M.-J. Kim Seoul National University, Republic of Korea
O20. Current practice in the management of the neck after chemo-radiotherapy in patients with locally advanced oro-pharyngeal SCC B. Bisase *, C. Skilbeck, C. Kerawala, C. Spencer Royal Marsden Hospital, UK Introduction: Patients who have a complete neck response to chemo-radiation (CRT) are unlikely to have residual viable tumour, thus questioning the need for planned neck dissection. Partial responders often need further assessment. PETCT is becoming the standard tool to assess primary site and neck disease response to CRT. There is ongoing debate about the timing of assessment, the best imaging technique and the extent of neck dissection (ND) with emerging evidence supporting more selective procedures with attendant decreases in morbidity. Whilst various trials strive to address these controversies, we hypothesise that current practices vary in the United Kingdom (UK). It was therefore the aim of this study to establish the current practice by head/ neck surgeons and oncologists. Methods: Three hundred questionnaires were disseminated to head/neck surgeons and oncologists. Information obtained included the respondents’ background, their preferred choice and timing of investigations, and the type of ND if indicated. Results: Responses revealed a noticeable variation in practice. There was a tendency toward personal choice rather than a multidisciplinary driven approach which itself may reflect an absence of guidelines and paucity of evidence-base. Although there was some agreement in the choice of ND, disparity remained regarding the timing of imaging and surgery. Conclusion: There is inconsistency in the management the neck in this patient cohort in the UK at present with a need to unify practice in order to improve patient care. This study exemplifies the need for long awaited results from current trials on this topic. doi:10.1016/j.oraloncology.2011.06.131
O21. Oral submucous fibrosis—A clinico-histopathological comparative study in population of southern Rajasthan, India J. Ahmed *, S. Goyal Manipal College of Dental Sciences, India Introduction: Oral submucous fibrosis (OSMF) is a precancerous condition associated with the use of betel/areca nut in various forms. This debilitating condition is seen as an insidious chronic disease affecting any part of the oral cavity and some times the pharynx. Although occasionally preceded by and/or associated with vesicle formation, it is always associated with a juxta-epithelial inflammatory reaction followed by a fibro elastic change of the lamina propria. It is characterized by restricted mouth opening, tongue protrusion and cheek rigidity.The relative risk for malignant transformation of this condition is quite high. Method: A hospital-based study was conducted on 100 OSMF cases to correlate the clinical staging with histopathological grading. A detailed history of each patient was recorded along with thorough clinical examination. Punch biopsy was performed for histopathological evaluation. Clinical staging of the disease in terms of the ability to open one’s mouth was correlated with histopathological grading. Results: In the present study, the age of the patient ranged from 20 to 50 years with a peak incidence from 21 to 29 years of age. The male to female ratio of OSMF cases was 5:1. All forms of Areca nut products were associated with OSMF. Chewing of panmasala was associated with early presentation of OSMF as compared to chewing of other products of Areca nut, although the total duration of the
S35
chewing habit was not significantly correlated to OSMF. It was also found that the patients who used panmasala with a greater frequency/day developed OSMF with a shorter duration of the habit. The maximum number of patients affected with OSMF were in clinical stage II and histopathological grade II. Discussion: In the present study, statistical analysis showed that there is no significant correlation between clinical staging and histopathological grading. Significant and direct correlation to the manifestation of OSMF was seen with frequency rather than duration of chewing. Although various degrees of epithelial dysplasia were observed, malignant transformation was not seen. A better understanding of the clinico-histopathological correlation can provide to be a good marker for the diagnosis, prognosis and severity of this multifactorial crippling disease. doi:10.1016/j.oraloncology.2011.06.132
O22. Identification of molecular markers for sentinel lymph node biopsy of oral squamous cell carcinoma R. Oka *, K. Nakashiro, H. Goda, Y. Nishikawa, H. Tanaka, H. Hamakawa Department of Oral and Maxillofacial Surgery, Ehime University Graduate School of Medicine, Japan Cervical lymph node metastasis is a potent prognostic factor in oral squamous cell carcinoma (OSCC). Management of the cN0 neck in OSCC is an important issue for the surgeons. Sentinel lymph node biopsy (SLNB) has received considerable attention for its role in deciding whether to perform neck dissection. We have performed the SLNB for cN0 cases routinely and reported the clinical usefulness. Accurate diagnosis of the metastasis in sentinel lymph nodes is important but depends on a heavy workload of the pathologist. We carried out a clinical study to evaluate a new automated assay system for cytokeratin 19 (CK19) mRNA, the one-step nucleic acid amplification (OSNA) method, to detect the lymph node metastasis of OSCC. The accuracy of OSNA was nearly 95%, but it could not detect in the case of no or low expression of CK19 mRNA in the primary tumor. In this study, we have attempted to identify novel molecular markers to find the harboring cancer cells in the lymph node. First, we determined the gene expression profiles in 7 metastatic lymph nodes from patients with OSCC, 1 normal lymph node, and 5 salivary gland tissues from non-cancerous patients by microarray analysis. We found the overexpression of 36 genes in all metastatic lymph nodes. Subsequently, we examined the expression of these genes in newly 13 metastatic lymph nodes and 7 normal lymph nodes by real-time quantitative RT-PCR method. Among the 36 genes, annexin A8-like 2 (ANXA8L2) and desmoglein 3 (DSG3) were commonly detected in metastatic lymph nodes at a much higher level but not in normal lymph nodes at all. Furthermore, we confirmed the expression of these genes in all of 34 metastatic lymph nodes including 8 false negative lymph nodes by OSNA. These results suggested that ANXA8L2 and DSG3 could be useful markers for detecting sentinel lymph node metastasis of OSCC. doi:10.1016/j.oraloncology.2011.06.133
O23. Evaluation of survivin as a prognostic marker in oral squamous cell carcinoma J.-Y. Yoon *, J.-H. Lee, H. Myoung, S.-M. Kim, M.-J. Kim Seoul National University, Republic of Korea