Squamous cell carcinoma of the oral cavity and the oropharynx in patients less than 40 years of age: a 20-year analysis

Abstract

Background: Squamous cell carcinoma mainly afflicts patients older than 40 years of age however, few cases are seen in younger patients. The aim of this study therefore was to determine the incidence of squamous cell carcinoma of the oral cavity and oropharynx in patients less than 40 years of age with a view to assessing the prognosis over a period of time.

Methods: This was a 20 years retrospective review of patients who were histologically diagnosed with squamous cell carcinoma of the oral cavity and the oropharynx at the Department of Cranio-Maxillo-Facial Surgery of the Hannover Medical School, Germany and had not received treatment anywhere else. Records of these patients were analysed for age and sex distribution, tumour staging and differentiation, location, treatment given, recurrences and metastasis, time between diagnosis and death or last contact with patient, and possible cause of death. Comparisons were also made with patients older than 40 years of age.

Results and discussion: A total of 977 patients treated for squamous cell carcinoma of the oral cavity and the oropharynx in the 20-year period of this study were included. Thirty eight (3.9 %) of the overall patient population were under 40 years of age. Among these, 30 (78.9%) were males and 8 (21.1%) were females. The incidence was highest in the 30-39 year age group accounting for 31 (81.6%) of the 38 patients. The moderately differentiated carcinoma was commonest (24; 63.2%). The floor of the mouth had the highest number of tumours (15; 39.5%), but none was seen in the oropharynx. Surgery alone was the main stay of treatment given to 26 (68.4%) patients. At the end of the study period, 13 (34.2%) patients had died of the tumour and the 5-year survival rate was 66.2%. In the older patient group (>40 years), 42.7% died from the tumour and the 5-year survival rate was 57.6%.

Conclusion: The results from the present study showed that young adults may have a better prognosis especially in terms of long term overall survival from oral and oropharyngeal carcinoma.

Figure 1

T-stages (based on T1-T4) and sex of the patients (n = 977). A comparison of men versus women using the log-rank test showed a highly significant result (p = 0.005).

Figure 2

T-stages (based on T1-T4) by age groups of patients (n = 977). A comparison of the patients less than 40 years with those older than 40 years shows no significant result using the log-rank test.

Figure 3

Graphical representation of the local recurrence-free survival time, of the 2 age groups, with the help of the product-limit method of Kaplan-Meier.

Figure 4

Graphical representation of the survival probability of the entire group, with the help the product-limit method of Kaplan-Meier.

Figure 5

Graphical representation of the survival probability of the 2 age groups, with the help of the product-limit method of Kaplan-Meier.