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Cancer of the Tongue in Patients Younger Than 40 Years: A Distinct Entity?

Cancer of the Tongue in Patients Younger Than 40 Years: A Distinct Entity? Abstract Background: An increase in the incidence of oral cancer among patients younger than 40 years has been reported worldwide. It has been suggested that the disease behaves more aggressively among young people. Objective: To evaluate the clinical and biologic behavior of tongue cancer among younger patients. Patients and Methods: Data on all patients younger than 40 years in whom tongue cancer was diagnosed in Finland between 1980 and 1989 (34 cases) were collected; pertinent clinical data were available for risk factor screening. A follow-up of at least 5 years or until death was available for all 34 patients. Immunocytochemical staining techniques were used to assess the expression of p53 and bcl-2 proteins, and p53 mutation analysis was performed by using the nonradioactive single-strand conformation polymorphism technique. Results: The incidence of tongue cancer in this age group in Finland did not change during the study period. The clinical behavior of tongue cancer in young people was not more aggressive compared with that of older patients in general, with the overall 5-year survival being as good as 70.6%. Altogether, p53 mutations were found in 17 of 33 tumors (51.5%). The p53 and bcl-2 protein expression was strong or moderate in 33.3% and 30.3% of the samples, respectively. Intense p53 protein expression was associated with the larger tumor size (P<.05). The poorest prognosis was found in patients with tumors greater than 4 cm in diameter (P=.01) or moderately or poorly differentiated cancer (P=.01). There was a trend for the adverse prognosis to accumulate in patients with moderately or poorly differentiated carcinoma and mutations in p53 (P=.09). Conclusions: The cause of tongue cancer in patients younger than 40 years seems to be multifactorial. Those patients had a similar clinical course, prognosis, and function of p53 as found in the reports of a normal age variation. Mutations of p53 seemed to be an additional prognostic marker that was associated with moderate or poor differentiation of the tumors.Arch Otolaryngol Head Neck Surg. 1996;122:1313-1319 References 1. LaVecchia C, Franceschi S, Levi F, et al. Diet and human oral carcinoma in Europe . Eur J Cancer B Oral Oncol. 1993;29:17-22.Crossref 2. Macfarlane GJ, Boyle P, Evstifeeva TV, et al. Rising trends of oral cancer mortality among males worldwide: the return of an old public health problem . Cancer Causes Control . 1994;5:259-265.Crossref 3. Jones JB, Lampe HB, Cheung HW. Carcinoma of the tongue in young patients . J Otolaryngol. 1989;18:105-108. 4. Byers RM. Squamous cell carcinoma of the oral tongue in patients less than thirty years of age . Am J Surg. 1975;130:475-478.Crossref 5. Lipkin A, Miller RH, Woodson GE. Squamous cell carcinoma of the oral cavity, pharynx, and larynx in young adults . Laryngoscope. 1985;95:790-793.Crossref 6. Carniol PJ, Fried MP. Head and neck carcinoma in patients under 40 years of age . Ann Otol Rhinol Laryngol. 1982;91:152-155. 7. Sarkaria JN, Harari PM. Oral tongue cancer in young adults less than 40 years of age: rationale for aggressive therapy . Head Neck. 1994;16:107-111.Crossref 8. Kuriakose M, Sankaranarayanan M, Nair MK, et al. Comparison of oral squamous cell carcinoma in younger and older patients in India . Eur J Cancer B Oral Oncol. 1992;28:113-120.Crossref 9. Chang F, Syrjänen S, Syrjänen K. Implications of the p53 tumor-suppressor gene in clinical oncology . J Clin Oncol. 1995;13:1009-1022. 10. Brennan JA, Boyle JO, Koch WM, et al. Association between cigarette smoking and mutation of the p53 gene in squamous-cell carcinoma of the head and neck . N Engl J Med. 1995;332:712-717.Crossref 11. Foster SA, Demers GW, Etscheid BG, et al. The ability of human papillomavirus E6 proteins to target p53 for degradation in vivo correlates with their ability to abrogate Actinomycin D—induced growth arrest . J Virol. 1994;68:5698-5705. 12. Sakai E, Rikimaru K, Ueda M, et al. The p53 tumor-suppressor gene and ras oncogene mutations in oral squamous-cell carcinoma . Int J Cancer. 1992;52: 867-872.Crossref 13. Wattel E, Preudhomme C, Hecquet B, et al. p53 mutations are associated with resistance to chemotherapy and short survival in hematologic malignancies . Blood. 1994;84:3148-3157. 14. Hockenbery D, Nunez G, Milliman C, et al. Bcl-2 is an inner mitochondrial membrane protein that blocks programmed cell death . Nature. 1990;348:334-336.Crossref 15. Lu Q-L, Hanby AM, Hajibagheri MAN, et al. Bcl-2 protein localizes to the chromosomes of mitotic nuclei and is correlated with the cell cycle in cultured epithelial cell lines . J Cell Sci. 1994;107:363-371. 16. Wang Y, Szekely L, Okan I, et al. Wild-type p53-triggered apoptosis is inhibited by bcl-2 in a v-myc induced T-cell lymphoma line . Oncogene. 1993;8: 3427-3431. 17. Lu Q-L, Elia G, Lucas S, et al. Bcl-2 proto-oncogene expression in Epstein-Barrvirus—associated nasopharyngeal carcinoma . Int J Cancer. 1993;53:29-35.Crossref 18. Chen J, Eisenberg E, Krutchkoff DJ, et al. Changing trends in oral cancer in the United States, 1935 to 1985: a Connecticut study . J Oral Maxillofac Surg. 1991;49:1152-1158.Crossref 19. Koch WM, Patel H, Brennan J, et al. Squamous cell carcinoma of the head and neck in the elderly . Arch Otolaryngol Head Neck Surg. 1995;121:262-265.Crossref 20. Shah JP, Candela FC, Poddar AK. The patterns of cervical lymph node metastases from squamous carcinoma of the oral cavity . Cancer . 1990;86:109-113.Crossref 21. Decroix Y, Nemetallah AG. Experience of the Curie Institute in treatment of cancer of the mobile tongue . Cancer . 1981;47:496-502.Crossref 22. Leipzig B, Cummings CW, Chung CT, et al. Carcinoma of the anterior tongue . Ann Otol Rhinol Laryngol . 1982;91:94-97. 23. Burns JE, Baird MC, Clark LJ, et al. Gene mutations and increased levels of p53 protein in human squamous cell carcinomas and their cell lines . Br J Cancer. 1993;67:1274-1284.Crossref 24. Zariwala M, Schmid S, Pfaltz M, et al. p53 gene mutations in oropharyngeal carcinomas: a comparison of solitary and multiple primary tumours and lymphnode metastases . Int J Cancer. 1994;56:807-811.Crossref 25. Mitsudomi T, Steinberg SM, Nau MM, et al. p53 gene mutations in non-small-cell lung cancer cell lines and their correlation with the presence of ras mutations and clinical features . Oncogene . 1992;9:1799-1805. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

Cancer of the Tongue in Patients Younger Than 40 Years: A Distinct Entity?

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References (26)

Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.1996.01890240021006
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Abstract

Abstract Background: An increase in the incidence of oral cancer among patients younger than 40 years has been reported worldwide. It has been suggested that the disease behaves more aggressively among young people. Objective: To evaluate the clinical and biologic behavior of tongue cancer among younger patients. Patients and Methods: Data on all patients younger than 40 years in whom tongue cancer was diagnosed in Finland between 1980 and 1989 (34 cases) were collected; pertinent clinical data were available for risk factor screening. A follow-up of at least 5 years or until death was available for all 34 patients. Immunocytochemical staining techniques were used to assess the expression of p53 and bcl-2 proteins, and p53 mutation analysis was performed by using the nonradioactive single-strand conformation polymorphism technique. Results: The incidence of tongue cancer in this age group in Finland did not change during the study period. The clinical behavior of tongue cancer in young people was not more aggressive compared with that of older patients in general, with the overall 5-year survival being as good as 70.6%. Altogether, p53 mutations were found in 17 of 33 tumors (51.5%). The p53 and bcl-2 protein expression was strong or moderate in 33.3% and 30.3% of the samples, respectively. Intense p53 protein expression was associated with the larger tumor size (P<.05). The poorest prognosis was found in patients with tumors greater than 4 cm in diameter (P=.01) or moderately or poorly differentiated cancer (P=.01). There was a trend for the adverse prognosis to accumulate in patients with moderately or poorly differentiated carcinoma and mutations in p53 (P=.09). Conclusions: The cause of tongue cancer in patients younger than 40 years seems to be multifactorial. Those patients had a similar clinical course, prognosis, and function of p53 as found in the reports of a normal age variation. Mutations of p53 seemed to be an additional prognostic marker that was associated with moderate or poor differentiation of the tumors.Arch Otolaryngol Head Neck Surg. 1996;122:1313-1319 References 1. LaVecchia C, Franceschi S, Levi F, et al. Diet and human oral carcinoma in Europe . Eur J Cancer B Oral Oncol. 1993;29:17-22.Crossref 2. Macfarlane GJ, Boyle P, Evstifeeva TV, et al. Rising trends of oral cancer mortality among males worldwide: the return of an old public health problem . Cancer Causes Control . 1994;5:259-265.Crossref 3. Jones JB, Lampe HB, Cheung HW. Carcinoma of the tongue in young patients . J Otolaryngol. 1989;18:105-108. 4. Byers RM. Squamous cell carcinoma of the oral tongue in patients less than thirty years of age . Am J Surg. 1975;130:475-478.Crossref 5. Lipkin A, Miller RH, Woodson GE. Squamous cell carcinoma of the oral cavity, pharynx, and larynx in young adults . Laryngoscope. 1985;95:790-793.Crossref 6. Carniol PJ, Fried MP. Head and neck carcinoma in patients under 40 years of age . Ann Otol Rhinol Laryngol. 1982;91:152-155. 7. Sarkaria JN, Harari PM. Oral tongue cancer in young adults less than 40 years of age: rationale for aggressive therapy . Head Neck. 1994;16:107-111.Crossref 8. Kuriakose M, Sankaranarayanan M, Nair MK, et al. Comparison of oral squamous cell carcinoma in younger and older patients in India . Eur J Cancer B Oral Oncol. 1992;28:113-120.Crossref 9. Chang F, Syrjänen S, Syrjänen K. Implications of the p53 tumor-suppressor gene in clinical oncology . J Clin Oncol. 1995;13:1009-1022. 10. Brennan JA, Boyle JO, Koch WM, et al. Association between cigarette smoking and mutation of the p53 gene in squamous-cell carcinoma of the head and neck . N Engl J Med. 1995;332:712-717.Crossref 11. Foster SA, Demers GW, Etscheid BG, et al. The ability of human papillomavirus E6 proteins to target p53 for degradation in vivo correlates with their ability to abrogate Actinomycin D—induced growth arrest . J Virol. 1994;68:5698-5705. 12. Sakai E, Rikimaru K, Ueda M, et al. The p53 tumor-suppressor gene and ras oncogene mutations in oral squamous-cell carcinoma . Int J Cancer. 1992;52: 867-872.Crossref 13. Wattel E, Preudhomme C, Hecquet B, et al. p53 mutations are associated with resistance to chemotherapy and short survival in hematologic malignancies . Blood. 1994;84:3148-3157. 14. Hockenbery D, Nunez G, Milliman C, et al. Bcl-2 is an inner mitochondrial membrane protein that blocks programmed cell death . Nature. 1990;348:334-336.Crossref 15. Lu Q-L, Hanby AM, Hajibagheri MAN, et al. Bcl-2 protein localizes to the chromosomes of mitotic nuclei and is correlated with the cell cycle in cultured epithelial cell lines . J Cell Sci. 1994;107:363-371. 16. Wang Y, Szekely L, Okan I, et al. Wild-type p53-triggered apoptosis is inhibited by bcl-2 in a v-myc induced T-cell lymphoma line . Oncogene. 1993;8: 3427-3431. 17. Lu Q-L, Elia G, Lucas S, et al. Bcl-2 proto-oncogene expression in Epstein-Barrvirus—associated nasopharyngeal carcinoma . Int J Cancer. 1993;53:29-35.Crossref 18. Chen J, Eisenberg E, Krutchkoff DJ, et al. Changing trends in oral cancer in the United States, 1935 to 1985: a Connecticut study . J Oral Maxillofac Surg. 1991;49:1152-1158.Crossref 19. Koch WM, Patel H, Brennan J, et al. Squamous cell carcinoma of the head and neck in the elderly . Arch Otolaryngol Head Neck Surg. 1995;121:262-265.Crossref 20. Shah JP, Candela FC, Poddar AK. The patterns of cervical lymph node metastases from squamous carcinoma of the oral cavity . Cancer . 1990;86:109-113.Crossref 21. Decroix Y, Nemetallah AG. Experience of the Curie Institute in treatment of cancer of the mobile tongue . Cancer . 1981;47:496-502.Crossref 22. Leipzig B, Cummings CW, Chung CT, et al. Carcinoma of the anterior tongue . Ann Otol Rhinol Laryngol . 1982;91:94-97. 23. Burns JE, Baird MC, Clark LJ, et al. Gene mutations and increased levels of p53 protein in human squamous cell carcinomas and their cell lines . Br J Cancer. 1993;67:1274-1284.Crossref 24. Zariwala M, Schmid S, Pfaltz M, et al. p53 gene mutations in oropharyngeal carcinomas: a comparison of solitary and multiple primary tumours and lymphnode metastases . Int J Cancer. 1994;56:807-811.Crossref 25. Mitsudomi T, Steinberg SM, Nau MM, et al. p53 gene mutations in non-small-cell lung cancer cell lines and their correlation with the presence of ras mutations and clinical features . Oncogene . 1992;9:1799-1805.

Journal

Archives of Otolaryngology - Head & Neck Surgery – American Medical Association

Published: Dec 1, 1996

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