Archives of Oral Biology
Volume 152,
August 2023
, 105735
Author links open overlay panel, , , ,
Abstract
Objective
To build a prognostic model for oral squamous cell carcinoma patients with type 2 diabetes mellitus.
Design
Oral squamous cell carcinoma patients with type 2 diabetes mellitus in Xiangya Hospital were studied. Patients during January 2011 to January 2015 were included in training set (n=146), and those during January 2017 to December 2020 were included in test set (n=81). Univariate and multivariate Cox regressions were used to screen independent prognostic variables. Nomogram was used to show the model. C-index, internal bootstrap resampling and external validation were used to evaluate the model.
Results
Six independent prognostic factors (T stage, N stage, pathological grade, metformin use, sulfonylureas use, and fasting blood glucose) were screened from training set. Based on the six variables, nomogram was constructed to predict the prognosis of oral squamous cell carcinoma patients with type 2 diabetes mellitus. C-index value was 0.728, and result of internal bootstrap resampling showed better prediction efficiency for one-year survival. All patients were divided into two groups according to total points calculated based on the model. Group with low total points experienced better survival than that with high total points both in training set and test set.
Conclusions
The model provides a relatively accurate method to predict the prognosis of oral squamous cell carcinoma patients with type 2 diabetes mellitus.
Introduction
Oral squamous cell carcinoma (OSCC), the most common type of oral cancer, accounts for 90% of all cancer types in oral cavity (Warnakulasuriya, 2009). In the past several years, new cases of oral cancer have been growing rapidly. According to the global cancer statistic, the number of new cases of 2020 is 22,849 more than that of 2018 (Bray et al., 2018; Sung et al., 2021). Patients diagnosed with early stage of OSCC usually experience a better 5-year survival rate (90%), while the 5-year survival rate of those diagnosed with later stage drops sharply to 30% (Omar, 2015). Researchers have developed many tools to predict the survival of OSCC patients. The most well-known one to us is the TNM staging system(Moeckelmann et al., 2018). According to the size of primary tumor, lymph node metastasis and distant metastasis, the prognosis of patients with OSCC can be preliminarily predicted. However, some other clinical factors can also affect the prognosis of patients with OSCC. Wang et al. constructed a prognostic model of OSCC based on clinicopathological data including age, sex, site, race, origin, grade, surgery, radiation and TNM stage (Wang et al., 2018). Nomograms of the model allowed clinicians to predict the long-term survival rate of OSCC patients more accurately.
Type 2 diabetes mellitus (T2DM), a complex chronic systemic disease, is charactered by insulin resistance and deficiency in insulin secretion, accounting for 95% diabetes mellitus patients(Xu et al., 2018). According to the prediction of the International Diabetes Federation (IDF), the population of diabetic patients will grow from 382 million in 2013–592million in 2035 by 55% (Shi & Hu, 2014). T2DM is closely related to the occurrence and development of various oral diseases. It was reported that T2DM and periodontitis could promote each other, T2DM could increase the risk of periodontitis by 34%, and the prevalence of T2DM was significantly higher in periodontitis patients(Wu et al., 2020). Some infectious diseases, such as oral candidiasis, could also be secondary to uncontrolled T2DM(Sampath et al., 2019). Diabetes is also closely related to OSCC. Referring to the statistics of Xiangya Hospital in China, OSCC patients accompanying with T2DM account for 14.3% of all OSCC patients (Hu et al., 2020). Predictably, this proportion will continue to increase as the number of people with T2DM increases. In our previous study, type 2 diabetes mellitus (T2DM) was an independent risk factor for OSCC patients (Hu et al., 2020). Thus, OSCC patients with T2DM a special population with unique prognostic characteristics. However, up to now, there has not been a prognostic model for OSCC patients with T2DM.
In this study, we aimed to construct a model that could predict the prognosis of OSCC patients with T2DM. The model will allow clinicians to relatively accurately predict the prognosis of patients based on their clinical and pathological characteristics, thereby assisting in determining treatment plans.
Section snippets
Patients
The training cohort of OSCC patients with T2DM during January 2011 to January 2015 of Xiangya Hospital presented in previous study were used to construct the prognostic model (Hu et al., 2020). Study design, sample size calculation, inclusion and exclusion criteria had been described in detail previously. OSCC patients diagnosed with T2DM in their past history and final diagnosis were included in this study. Squamous cell carcinoma located at “tongue”, “buccal mucosa”, “gingiva”, “floor of the
Summary Statistics
In total, 146 OSCC patients with T2DM were used to construct the prognostic model. The follow-up time ranged from the lowest 10 days to the highest 1825 days, with a mean follow up of 1186.82 days (standard error, 62.25). Among all variables, missing values were found in 8 variables including urban and rural residence (2.1%), education level (9.6%), tobacco use (0.7%), alcohol consumption (2.1%), betel quid chewing (2.1%), pathological grade (6.2%), fasting blood glucose (8.2%) and HbA1c
Discussion
T2DM and cancer are becoming increasingly prevalent all over the world. More and more studies show that T2DM can increase the incidence rate of cancer(Shlomai et al., 2016). In T2DM patients, the prevalence of oral cancer was 0.25%, and patients with oral cancer combined with diabetes mellitus experienced a higher mortality than controls(Ramos-Garcia et al., 2021). A comparative study in Taiwan, China, conducted by Tseng CH, showed that metformin could decrease oral cancer risk in patients with
Conclusions
In conclusion, we constructed a prognostic model for predicting the prognosis of OSCC patients with T2DM by 6 clinicopathological factors, including T stage, N stage, pathological grade, metformin use, sulfonylureas use and fasting blood glucose level. As some controllable factors, we suggest that OSCC patients with T2DM should strictly control their blood glucose in a relatively normal range, and give priority to the metformin use to control T2DM without affecting the efficacy. Finally,
Funding
This work was supported by the National Natural Science Foundation [82170973], Project of National Center for Clinical Medical Research of Geriatrics [2021LNJJ08], and Hunan Postgraduate Scientific Research Innovation Project (key project) [CX20220118].
CRediT authorship contribution statement
Xin Hu: the conception and design of the study, acquisition of data, analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, final approval of the version to be submitted. Haofeng Xiong: acquisition of data, analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, final approval of the version to be submitted. Shiying Huang: the conception and design of the study,
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgments
None.
References (29)
- A. Almangush et al.
Staging and grading of oral squamous cell carcinoma: An update
Oral Oncology
(2020)
- S.C. Chang et al.
Hyperglycemia, tumorigenesis, and chronic inflammation
Critical Reviews in Oncology/Hematology
(2016)
- H. Chen et al.
Sulfonylurea receptor 1-expressing cancer cells induce cancer-associated fibroblasts to promote non-small cell lung cancer progression
Cancer Letters
(2022)
(Video) Oral squamous cell carcinoma : Basics - X. Hu et al.
Metformin reduces the increased risk of oral squamous cell carcinoma recurrence in patients with type 2 diabetes mellitus: A cohort study with propensity score analyses
Surgical Oncology
(2020)
- N. Moeckelmann et al.
Prognostic implications of the 8th edition American Joint Committee on Cancer (AJCC) staging system in oral cavity squamous cell carcinoma
Oral Oncology
(2018)
- S. Patil
Metformin treatment decreases the expression of cancer stem cell marker CD44 and stemness related gene expression in primary oral cancer cells
Archives of Oral Biology
(2020)
- Y. Shi et al.
The global implications of diabetes and cancer
Lancet
(2014)
- B. Thakkar et al.
Metformin and sulfonylureas in relation to cancer risk in type II diabetes patients: a meta-analysis using primary data of published studies
Metabolism
(2013)
- A. Vancura et al.
Metformin as an anticancer agent
Trends Pharmacological Science
(2018)
- S. Warnakulasuriya
Global epidemiology of oral and oropharyngeal cancer
Oral Oncology
(2009)
Metformin inhibits proliferation of oral squamous cell carcinoma cells by suppressing proteolysis of nerve growth factor receptor
Archives of Oral Biology
(2021)
Natural products for the treatment of type 2 diabetes mellitus: Pharmacology and mechanisms
Pharmacology Research
(2018)
Increased cancer-related mortality for patients with type 2 diabetes who use sulfonylureas or insulin
Diabetes Care
(2006)
Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries
CA: A Cancer Journal for Clinicians
(2018)
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ORCID: 0000-0003-1430-0672
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ORCID: 0000-0002-3213-4041
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ORCID: 0009-0007-5200-7932
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ORCID: 0000-0002-5257-0051
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ORCID: 0000-0001-7466-3999
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FAQs
What is the most important prognostic factor in oral squamous cell carcinoma? ›
Tumor grade (p=0.007), tumor thickness (p=0.012), and LVI (p=0.0003) also predicted for distant recurrence. Nodal stage is a stronger clinical prognosticator for survival and recurrence in oral SCC than patient or tumor factors including tumor stage, bone invasion, and type of bone resection.
What is the prognosis for oral squamous cell carcinoma? ›Prognosis for Oral Squamous Cell Carcinoma
For localized carcinoma of the floor of the mouth, 5-year survival is 75%. Lymph node metastasis decreases survival rate by about half. Metastases reach the regional lymph nodes first and later the lungs. For lower lip lesions, 5-year survival is 90%, and metastases are rare.
Tumor expression of miR-448 is a prognostic marker in oral squamous cell carcinoma | BMC Cancer | Full Text.
Can diabetes cause squamous cell carcinoma? ›Squamous cell carcinoma (SCC) is one of the most common cancers worldwide. Additionally, diabetes mellitus (DM) is a high prevalent comorbidity and the amount of patients with DM is expected to significantly increase. Recent studies have found an increased risk of developing SCC in patients with DM.
Which squamous cell carcinoma has best prognosis? ›Patients with stage I, II, or III cancer have the best survival, whereas patients with stage IV or recurrent cancer who are older than 66.5 years have the worst survival. Patients with stage IV or recurrent cancer who are younger than 66.5 years have intermediate survival.
What is the prognostic significance of Ki 67 positivity in oral squamous cell carcinoma? ›The Ki-67 expression is significantly higher in tissues with moderately –differentiated or poorly differentiated squamous cell carcinoma and moderate or severe Oral epithelial dysplasia and provides an objective criterion for determining the severity of OED and histological grading of OSCC.
What are the prognostic indicators? ›A situation or condition, or a characteristic of a patient, that can be used to estimate the chance of recovery from a disease or the chance of the disease recurring (coming back).
What are examples of prognostic markers? ›Examples of prognostic biomarkers are PSA level at the time of a prostate cancer diagnosis or the PIK3CA mutation status of tumors in women with human epidermal growth factor receptor 2 (HER2) –positive metastatic breast cancer.
What are the prognostic factors influencing the survival difference of oral tongue squamous cell carcinoma? ›For oral tongue squamous cell carcinoma, radiotherapy was a good prognostic factor. On the contrary, a tumor with large vertical size, closed surgical margin, poor histologic grade, and radical neck dissection in the operated group were poor prognostic factors.
Which patient is at highest risk for squamous cell carcinoma? ›Age over 50: Most SCCs appear in people over age 50. Fair skin: People with fair skin are at an increased risk for SCC. Gender: Men are more likely to develop SCC. Sun-sensitive conditions including xeroderma pigmentosum.
What makes squamous cell carcinoma aggressive? ›
The risk of aggressive squamous cell carcinoma of the skin may be increased in cases where the cancer: Is particularly large or deep. Involves the mucous membranes, such as the lips.
What organs does squamous cell carcinoma spread to? ›If left untreated, squamous cell carcinoma can spread to nearby lymph nodes, bones or distant organs (such as the lungs or liver). Normal squamous tissue usually appears flat. When this tissue develops cancer it can appear as round masses that are can be flat, raised, or ulcerated.
How many years does it take for squamous cell carcinoma to spread? ›Metastasis of cutaneous squamous cell carcinoma (cSCC) is rare. However, certain tumor and patient characteristics increase the risk of metastasis. Prior studies have demonstrated metastasis rates of 3-9%, occurring, on average, one to two years after initial diagnosis [6].
Is oral squamous cell carcinoma aggressive? ›Tongue squamous cell carcinoma is one of the most aggressive tumours in behaviour. Even at early stages may the patient need to be submitted to a treatment plan consisting of radio/chemotherapy besides surgical removal of the tumour (31).
Is squamous cell carcinoma in mouth curable? ›Small changes to the DNA of the squamous cells make the cells grow abnormally. These mutated cells accumulate, forming a tumor that grows in the mouth and often spread to lymph nodes in the neck. Oral cancer is curable if detected at an early stage.
What is the most important risk factor for squamous cell carcinoma? ›Most squamous cell carcinomas of the skin result from prolonged exposure to ultraviolet (UV) radiation, either from sunlight or from tanning beds or lamps. Avoiding UV light helps reduce your risk of squamous cell carcinoma of the skin and other forms of skin cancer.
What is the most important prognostic factor? ›The most important prognostic factor in all human cancers is the stage at presentation, which is the anatomic extent of the disease.
What features are important in the prognosis of carcinoma? ›Some of the factors that affect prognosis include: The type of cancer and where it is in your body. The stage of the cancer, which refers to the size of the cancer and if it has spread to other parts of your body. The cancer's grade, which refers to how abnormal the cancer cells look under a microscope.