Objective: To explore the survival factors and construct a prognostic index (PI) for oral squamous cell carcinoma (OSCC). Methods: From January 2004 to June 2016, a total of 634 patients with pathologically confirmed OSCC were recruited in a hospital of Fujian. The clinical and follow-up data of all the patients with pathologically confirmed OSCC were collected to identify the factors influencing the prognosis of OSCC. All the patients were randomly divided into two groups: modeling group (modeling dataset, n=318) and validation group (validation dataset, n=316). Randomization was carried out by using computer-generated random numbers. In the modeling dataset, survival rates were calculated using Kaplan-Meier method and compared using the log-rank test. Cox regression model was used to estimate the hazard ratio (HRs) and 95% confidence intervals (CIs) of prognosis factors. An PI for OSCC patients prognostic prediction model was developed based on β value of each significant variable obtained from the multivariate Cox regression model. Using the tertile analysis, patients were divided into high-risk group, moderate-risk group, and low-risk group according to the PI, the Akaike information criterion (AIC) and Harrell's c-statistic (C index) were used to evaluated the model's predictability. Results: Results from the multivariate Cox regression model indicated that aged ≥55 years (HR=2.22, 95%CI: 1.45-3.39), poor oral hygiene (HR=2.12, 95%CI: 1.27-3.54), first diagnosis of lymph node metastasis (HR=5.78, 95%CI: 3.60-9.27), TNM stage Ⅲ-Ⅳ (stage Ⅰ as reference) (HR=2.43, 95%CI: 1.10-5.37) and poor differentiation (well differentiation as reference) (HR=2.53, 95%CI: 1.60-4.01) were the risk factors influencing the prognosis of OSCC. The PI model had a high predictability in modeling group and validation group (AIC and C index were 1 205.80, 0.700 2 and 1 150.47, 0.737 3). Conclusion: Age, poor oral hygiene, first diagnosis of lymph node metastasis, TNM stage and histological grade were factors associated with the prognosis of OSCC, and the PI model has a certain significance in the clinical treatment of OSCC.目的： 探讨福建省口腔鳞状细胞癌（OSCC）患者预后影响因素并构建预后指数（PI）。 方法： 收集福建医科大学附属第一医院口腔颌面外科2004年1月至2016年6月经病理确诊634例OSCC患者的临床资料，并进行随访，将患者随机分为建立模型组（建模组，318例）和验证模型组（验证组，316例）。在建模组，运用Kaplan-Meier法计算生存率，log-rank检验比较生存率差别，采用Cox比例风险回归模型探讨OSCC患者预后影响因素并计算死亡风险比值（HR）及其95%CI，以模型组中有意义的预测变量的β值计算PI。运用三分位法将患者分为高危组、中危组和低危组，并在验证组中采用赤池信息准则（AIC）和Harrell一致性指数（Harrell’s c-index，C）检验模型的预测效能。 结果： Cox比例风险回归模型分析发现，OSCC患者中年龄≥55岁的HR值（95%CI）为2.22（1.45~3.39）；口腔卫生较差的HR值（95%CI）为2.12（1.27~3.54）；首诊淋巴结转移的HR值（95%CI）为5.78（3.60~9.27）；TNM分期为Ⅲ~Ⅳ期（Ⅰ期为参照）的HR值（95%CI）为2.43（1.10~5.37）；组织分化程度为低分化（高分化为参照）的HR值（95%CI）为2.53（1.60~4.01）。建模组和验证组中预后模型的预测效能良好（AIC和C值分别为1 205.80、0.700 2和1 150.47、0.737 3）。 结论： 年龄、口腔卫生、首诊断淋巴结转移、TNM分期和组织病理学分级是OSCC预后影响因素，构建PI模型可有效指导临床治疗。.
Background: Although previous studies have explored the associations of modifiable lifestyle factors with oral cancer risk, few studies integrated these factors and established predictive tools for oral cancer risk in different sexes. Methods: Using a case-control study design, a total of 978 oral cancer cases and 2646 healthy controls were recruited in this study. Nomograms were constructed according to significant factors in multivariable logistic regression. Risk scores were calculated based on the nomograms and quantified the risk of oral cancer using restricted cubic spline. Results: Multivariate analyses demonstrated that smoking, alcohol drinking, tea, intake of fish, seafood, vegetables, fruits, teeth loss, regular dental visits and repetitive dental ulcer were independent factors for male oral cancer. Passive smoking, age at first intercourse, cooking oil fumes exposure, tea, intake of beans, vegetables, fruits, teeth loss, regular dental visits and repetitive dental ulcer were associated with female oral cancer. Then, two nomograms were developed for predicting the probability of oral cancer in men and women with the C-index of 0.768 (95% CI: 0.723-0.813) and 0.700 (95% CI: 0.635-0.765), respectively. Restricted cubic splines graphically revealed the risk of oral cancer in individuals with different risk scores. Moreover, the risk escalated continuously with the increasing number of the risk scores among both sexes. Conclusions: Combining nomograms with risk scores developed in this study could precisely predict oral cancer occurrence and provide an accurate risk assessment.
// Lingjun Yan 1, 2, * , Fa Chen 1, 2, * , Fengqiong Liu 1, 2, * , Yu Qiu 4, 5 , Jing Wang 6 , Junfeng Wu 1, 3 , Xiaodan Bao 1, 3 , Zhijian Hu 1, 2 , Xiane Peng 1, 2 , Xu Lin 2, 3 , Lin Cai 1 , Lisong Lin 4, 5 and Baochang He 1, 2 1 Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fujian, China 2 Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fujian, China 3 Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian, China 4 Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fujian, China 5 Laboratory of Facial Plastic and Reconstruction of Fujian Medical University, Fujian, China 6 Laboratory Center, The Major Subject of Environment and Health of Fujian Key Universities, School of Public Health, Fujian Medical University, Fujian, China * These authors have contributed equally to the work Correspondence to: Lisong Lin, email: Dr_lsling@126.com Baochang He, email: hbc517@163.com Keywords: oral squamous cell carcinoma, oral fissure, modifiable factors, alcohol consumption, case-control study Received: June 14, 2017 Accepted: August 04, 2017 Published: August 24, 2017 ABSTRACT The aim of this study was to explore differences in the effects of modifiable factors on oral squamous cell carcinoma (OSCC) occurring in the lower oral fissure (LOF) and upper oral fissure (UOF). We conducted a case-control study with 697 OSCC patients (119 UOF and 578 LOF) and 1910 frequency-matched controls in Fujian province, China. Data on demographic characteristics and possible modifiable factors was collected using a structured questionnaire. Unconditional logistic regression was utilized to calculate the odds ratios (ORs) and corresponding 95% confidence intervals (CIs). Alcohol drinking was more strongly associated with an increased risk of OSCC-LOF than OSCC-UOF. Tobacco smoking, the number of teeth lost ≥5, wearing denture, and recurrent oral ulceration showed similarly associations with OSCC-LOF and -UOF risk. Similarly, the beneficial effects of tea consumption, tooth-brushing ≥2times per day, high intake of fresh fish, seafood, green-leafy vegetables, other vegetables and fruits were not significantly different on OSCC-LOF and -UOF. Although most of the modifiable factors exert similar effects on both OSCC sites, this study suggests that the sites of oral cavity in LOF may be affected more by alcohol drinking than the sites in UOF. Further studies with larger samples are warranted to confirm our findings.
Abstract Background To assess the prognostic role of gamma‐glutamyl transpeptidase to lymphocyte count ratio (GLR) and develop a prognostic nomogram for patients with oral cancer. Methods A prospective cohort ( n = 1011) was conducted during July 2002 to March 2021 in Southeastern China. Results The median follow‐up time was 3.5 years. Multivariate Cox regression (OS: HR = 1.51, 95% CI: 1.04, 2.18) and Fine–Gray model (DSS: HR = 1.68, 95% CI: 1.14, 2.49) both showed that high GLR could act as an indicator of poor prognosis. A nonlinear dose–response relationship was observed between continuous GLR and the risk of all‐cause mortality ( p for overall = 0.028, p for nonlinear = 0.048). Compare with TNM stage, time‐dependent ROC curve proved that GLR‐based nomogram model performs better in predicting prognosis (the area under curve for 1‐, 3‐, and 5‐years mortality: 0.63, 0.65, and 0.64 vs. 0.76, 0.77, and 0.78, p < 0.001). Conclusion GLR might be a useful tool in predicting prognosis for patients with oral cancer.
To evaluate whether exosomal circRNAs could serve as diagnostic biomarkers for the accurate preoperative prediction of lymph node metastasis (LNM) risk in oral squamous cell carcinoma (OSCC) patients.A combinative strategy of exosomal circRNAs microarray and qRT-PCR verification was employed to dig LNM-related circRNA signatures. Then, a dynamic nomogram was developed based on candidate circRNAs and preoperative clinical features and the calibration, discrimination, and clinical use of the nomogram were evaluated.According to the microarray, three circRNAs derived from the tumor were associated with preoperative LNM risk, including hsa_circRNA_047733, hsa_circRNA_024144 and hsa_circRNA_403472. The hsa_circRNA_047733 was further verified to be significantly downregulated in patients with LNM (+) as compared with those with LNM (-) (p = 0.007). Patients with the higher expression of hsa_circRNA_047733 showed a lower risk of LNM (multivariate-adjusted OR = 0.22, 95%CI: 0.06-0.83). The bioinformatics prediction showed that hsa_circRNA_047733 might sponge miR-4464/miR-4748 to regulate RPS21 expression. A dynamic nomogram integrating exosomal hsa_circRNA_047733 with five clinicopathological characteristics (tumor site, leukocyte level, maximum tumor diameter, and LNM reported by MRI and preoperative biopsy differentiation) was developed. The model displayed an excellent discrimination ability (AUC = 0.868, 95%CI: 0.781-0.955) and great calibration. The decision curve revealed a higher net benefit superior to the baseline model at an 80% threshold probability.The data provide preliminary evidence that exosomal hsa_circRNA_047733 might be a novel biomarker for the LNM of OSCC. The hsa_circRNA_047733-based dynamic nomogram could serve as a convenient preoperative assessment tool to predict the risk of LNM for OSCC patients.
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