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. 2022 Apr:127:105803.
doi: 10.1016/j.oraloncology.2022.105803. Epub 2022 Mar 5.

Young non-smokers with oral cancer: What are we missing and why?

Cristina Valero  1 , Avery Yuan  1 , Daniella K Zanoni  1 , Emily Lei  1 , Snjezana Dogan  2 , Jatin P Shah  1 , Luc G T Morris  1 , Richard J Wong  1 , Aviram Mizrachi  3 , Snehal G Patel  1 , Ian Ganly  4
Affiliations

Young non-smokers with oral cancer: What are we missing and why?

Cristina Valero et al. Oral Oncol. 2022 Apr.

Abstract

Objectives: There has been an increase in young non-smokers (YNS) who develop oral cavity squamous cell carcinomas (OSCC). Oncological outcomes in YNS are controversial and etiology has not been well-defined. We hypothesize that the etiology of cancer development in YNS and their poor outcome is related to an impaired immune system.

Materials and methods: From a database of 2073 OSCC patients treated with primary surgery between 1985 and 2015, 9% were young patients. We categorized patients as: ≤40 years-old/non-smokers (n = 100), ≤40 years-old/smokers (n = 80), >40 years-old/non-smokers (n = 595) and >40 years-old/smokers (n = 1298). Patient and tumor variables were used to calculate propensity scores and stabilized inverse probability of treatment weights were calculated. Weighted proportional hazard models were performed. Survival and recurrence outcomes of YNS were compared to the other 3 groups. Host immune status of YNS measured by peripheral blood neutrophil-to-lymphocyte ratio (NLR) was compared to 2 control groups (YNS with thyroid cancer and YNS with benign pathologies).

Results: After adjusting for tumor and host factors, YNS had a higher probability of death compared to young smokers. This was driven by a higher incidence of regional and distant recurrences. Host factors showed a strong association with outcomes suggesting YNS may have an impaired immune system. Compared to the control cohorts YNS with OSCC had a higher NLR (p = .006).

Conclusion: When adjusted by relevant covariates, YNS with OSCC have poorer survival than their young smoker counterparts. Our results suggest that an impaired immune system may be partly responsible for OSCC development and poorer outcomes in YNS.

Keywords: Host; Immune status; NLR; Non-smokers; Oral cancer; Outcomes; Young patients.

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Conflict of interest statement

Conflict of interest:

The authors declare no conflicts of interest pertinent to this work. Snehal G. Patel has a patent PCT/US2016/026717 Methods of Cancer Detection Using PARPI-FL pending, holds equity in Summit Biomedical Imaging, has a patent US 10,016,238 B2 Apparatus, system and method for providing laser steering and focusing for incision, excision and ablation of tissue in minimally-invasive surgery, holds equity in ColdSteel Laser Inc, has a patent PCT/US2014/073053 Systems, methods, and apparatus for multichannel imaging of fluorescent sources in real time, has a patent PCT/US2015/065816 Cyclic peptides with enhanced nerve-binding selectivity, nanoparticles bound with said cyclic peptides, and use of same for real-time in vivo nerve tissue imaging and has a patent PCT/US2016/066969 Imaging systems and methods for tissue differentiation, e.g., for intraoperative visualization.

Figures

Figure 1.
Figure 1.
Probability of death and death of cancer based on age and smoking status before (A and C) and after (B and D) adjusting for sex, alcohol use, comorbidities, tumor site, pathological overall stage (AJCC 8th Ed), and adjuvant treatment
Figure 2.
Figure 2.
Probability of local, regional and distant recurrence based on age and smoking status before (A, C and E) and after (B, D and F) adjusting for sex, alcohol use, comorbidities, tumor site, pathological overall stage (AJCC 8th Ed), and adjuvant treatment
See this image and copyright information in PMC

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