Juan Seoane

Is diagnostic delay related to advanced-stage oral cancer? A meta-analysis

Diagnostic delay in oropharyngeal cancer may be associated with poor prognosis. As controversy exists on this topic because of contradictory results, the aim of this study was to perform a systematic review of the relationship between total diagnostic delay and advanced disease stages. A systematic search of MEDLINE, EMBASE, and ISI proceedings was made to identify observational studies that provided relative risks (RRs) and 95% confidence intervals (CIs) for patients with confirmed pathological diagnosis. The outcome of interest was disease stage (TNM classification), while the exposure of interest was the total diagnostic delay. The study-specific adjusted log RRs for cohort studies were weighted by the inverse of their variance to compute a pooled RR and its 95% CI. The fixed-effects pooled RR of advanced stages of oropharyngeal cancer when diagnostic delay is present was 1.32 (95% CI: 1.07-1.62). This association was stronger when the analysis was restricted to oral cancer (pooled RR: 1.47; 95% CI: 1.09-1.99) and when delay was longer than 1 month (pooled RR: 1.69; 95% CI: 1.26-2.77). The probability for patients with delayed diagnosis to present an advanced-stage tumour at diagnosis was significantly higher than that of patients with no delay in diagnosis. However, new prospective studies with strict methodology are needed to shed more light on this association.

Oral lichen planus: a clinical and morphometric study of oral lesions in relation to clinical presentation

Oral lichen planus (OLP) is a chronic inflammatory disease with different clinical presentations that can be classified as reticular or atrophic-erosive. Sixty-two OLP patients were studied to evaluate the clinical-pathologic characteristics of their OLP lesions and to investigate possible differences in their biological behavior. The most common clinical presentation was the reticular type (62.9% vs 37.1%). Atrophic-erosive presentations showed significantly longer evolution (chi square=4.454; p=0.049), more extensive lesions (chi square=16.211; p=0.000) and more sites affected than reticular ones (chi square=10.048; p=0.002). Atrophic-erosive OLP was more frequently found on the tongue, gingiva and floor of the mouth. No statistically significant differences could be identified between reticular and atrophic-erosive clinical presentations in terms of age, sex, tobacco habit, plasma cortisol level and depth of inflammatory infiltrate. We concluded that the classification of OLP lesions as reticular vs atrophic-erosive is a simple, easy to use classification that can identify clinical presentations with different biological behavior.

Impact of delay in diagnosis on survival to head and neck carcinomas: a systematic review with meta‐analysis

Clin. Otolaryngol. 2012, 37, 99–106

Metastatic tumours to the oral cavity: a survival study with a special focus on gingival metastases

AIMS To describe survival from oral metastases, particularly gingival metastases, and to identify clinical prognostic variables. MATERIALS AND METHODS A series of 39 patients were studied, analysing age, gender, primary tumour site, oral metastases site and histological type. RESULTS Mean age: 62.3+/-9.2 years, with similar prevalence by gender. The most frequent sites for primary tumours were the kidney (20.5%), lung (20.5%) and breast (20.5%). Gingival metastases represented 63.6% of all oral soft tissue metastases (7/11). The average time between primary tumour diagnosis and appearance of the gingival metastases was 9.7+/-13.4 months. The median survival time since gingival metastases appearance was 5.2 months [95% confidence interval (CI)=0-13.6]; no statistically significant difference with other oral locations was found by the Kaplan-Meier curves (log rank: 0.29; p>0.05). Oral metastases involving the gingiva were more frequently found in the maxilla (85.7%versus 14.3%), whereas intra-osseous metastatic tumours were more frequent in the mandible (77.8%versus 22.2%; p<0.05; odds ratio=21; 95% CI=2.0-210.1). None of the variables considered had a prognostic value as indicated by the Kaplan-Meier test. PRACTICAL IMPLICATIONS The data in this paper show that 25% (and in other studies up to 37%) of oral metastases came from unknown primary tumours; thus a biopsy with histopathologic analysis is mandatory for every patient with a gingival mass. CONCLUSIONS This study reinforces the significance of gingival metastases as a poor prognosis indicator. Dental practitioners should suspect that gingival masses mimicking benign or inflammatory lesions may represent a sign of underlying malignant tumours.

Factors related to late stage diagnosis of oral squamous cell carcinoma.

Aims: To identify factors related to advanced-stage diagnosis of oral cancer to disclose high-risk groups and facilitate early detection strategies. Study design: An ambispective cohort study on 88 consecutive patients treated from January 1998 to December 2003. Inclusion criteria: pathological diagnosis of OSCC (primary tumour) at any oral site and suffering from a tumour at any TNM stage. Variables considered: age, gender, smoking history, alcohol usage, tumour site, macroscopic pattern of the lesion, co-existing precancerous lesion, degree of differentiation, diagnostic delay and TNM stage. Results: A total of 88 patients (mean age 60±11.3; 65.9% males) entered the study. Most patients (54.5%) suffered no delayed diagnosis and 45.5% of the carcinomas were diagnosed at early stages (I-II). The most frequent clinical lesions were ulcers (70.5%). Most cases were well- and moderately-differentiated (91%). Univariate analyses revealed strong associations between advanced stages and moderate-poor differentiation (OR=4.2; 95%CI=1.6-10.9) or tumour site (floor of the mouth (OR=3.6; 95%CI=1.2-11.1); gingivae (OR=8.8; 95%CI=2.0-38.2); and retromolar trigone (OR=8.8; 95%CI=1.5-49.1)). Regression analysis recognised the site of the tumour and the degree of differentiation as significantly associated to high risk of late-stage diagnosis. Conclusions: Screening programmes designed to detect asymptomatic oral cancers should be prioritized. Educational interventions on the population and on the professionals should include a sound knowledge of the disease presentation, specifically on sites like floor of the mouth, gingivae and retromolar trigone. More studies are needed in order to analyse the part of tumour biology on the extension of the disease at the time of diagnosis. Key words: Oral cancer, advanced-stage, diagnosis, cohort study.

Oral self-injury: an update.

BACKGROUND Self-inflicted oral injuries of organic origin are particularly common in certain diseases, syndromes, and systemic disorders. In this article, we discuss the characteristics of these oral lesions and their treatment. LITERATURE SEARCH The authors have reviewed the most relevant literature relating to oral self-injury through a search in textbooks and published articles included in the Medline database for the years 1970-2010, and selected published cases from the last two decades. RESULTS The majority of the literature on oral self-injury is in the form of case reports. Self-injury is particularly prevalent in patients with Lesch-Nyhan syndrome, a heterogeneous group of neurological disorders, congenital insensitivity to pain with anhidrosis, and mental retardation. It is most common in males in the early years of life, and the sites most frequently involved are the lower lip and the tongue. Therapeutic approaches in these patients have included psychological and pharmacological treatment, intraoral devices, and surgical procedures. CLINICAL IMPLICATIONS Intraoral devices are the best therapeutic option for self-injury of organic origin, although this approach is not free of complications. The current lack of standardized treatment protocols for oral self-injury means that therapy must be individualized.

Poorly differentiated oxyphilic (Hürthle cell) carcinoma arising in lingual thyroid: A case report and review of the literature

Clinically significant lingual thyroid is an unusual developmental anomaly, and carcinoma arising in lingual thyroid, an extremely rare entity. Here we describe the cytologic, histologic, immunohistochemical, and ultrastructural findings of the first poorly differentiated oxyphilic (Hürthle cell) carcinoma described in lingual thyroid along with a review of the literature. Carcinoma arising in lingual thyroid was reported in 12 males and 21 females age 12 to 86 yr (mean age: 40). Because in nonneoplastic lingual thyroid there exists an intimate and irregular relationship of normal follicles with the surrounding skeletal muscle fibers, unequivocal infiltration, with desmoplastic response, and/or vascular invasion should be demonstrated before making a diagnosis of carcinoma. Immunostain for thyroglobulin is the most useful marker for the differential diagnosis. Although, in some older cases, the precise histologic type is difficult to determine, follicular carcinoma seems to be prevalent. This contrasts with the predominance of the papillary type in thyroglossal duct-associated carcinoma. This fact is probably related to the history of hypothyroidism and compensatory hyperplasia secondary to the absence of the orthotopic gland, like that occurring in areas of endemic goiter.

Proliferative activity and diagnostic delay in oral cancer

Tumor stage may relate to the chronology of neoplasm growth and has been used as an outcome variable when studying diagnostic delay in oral cancer. However, tumor growth rate may act as a confounding factor.

Association between periodontitis and ischemic stroke: a systematic review and meta-analysis

Several observational studies have suggested an association between periodontitis and cerebral ischemia. This meta-analysis aimed to investigate whether this link exists, and if so, the degree to which it is significant. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline for systematic review was used. The search strategy included using electronic databases and hand searching works published up to March 2015. MEDLINE via PubMed, EMBASE, Proceedings Web of Science and Current Contents Connect were searched by two independent reviewers. Case-control, cross-sectional or cohort studies including patients with measures of periodontitis and ischemic stroke were eligible to be included in the analysis. Quality assessments of selected studies were performed. From a total of 414 titles and abstracts, 57 potentially relevant full text papers were identified. After inclusion criteria were applied, 8 studies were included in the present systematic review (5 case-control and 3 cohort studies). Although it was not the intention, cross-sectional studies were excluded due to eligibility criteria were not accomplished. Therefore, meta-analyses were conducted with data retrieved from the 8 studies included. These meta-analyses showed statistically significant association between periodontitis and ischemic stroke in both cohort pooled relative risks at 2.52 (1.77–3.58), and case-control studies pooled relative risks at 3.04 (1.10–8.43). In conclusion, the present meta-analysis demonstrated an association between periodontitis and ischemic stroke. However, well-designed prospective studies should be carried out to provide robust evidence of the link between both diseases. In regards to ischemic stroke subtypes, further case-control studies should be carried out to investigate whether there is any association between the different subtypes of cerebral infarcts and periodontitis.

Is Periodontal Disease Associated with Alzheimer's Disease A Systematic Review with Meta-Analysis

Background: In the last decade, several observational studies have suggested that there exists an association between periodontal disease (PD) and Alzheimers disease (AD). The aim of this systematic review was to investigate whether or not this link exists. Summary: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline for systematic review was used and registered at PROSPERO (CRD42016035377). The search strategy included using electronic databases and by hand searching articles published up to January 2016. MEDLINE via PubMed, EMBASE and Web of Science were searched by 2 independent reviewers. Observational studies including patients meeting criteria for both AD and PD were eligible to be included in the analysis. Quality assessment of selected studies was performed by the Newcastle-Ottawa Scale. From a total of 550 titles and abstracts, 5 studies were included (2 cross-sectional, 2 case-control and one cohort study) in the review. A fixed effects meta-analysis showed that the presence of PD is associated with the presence of AD (OR 1.69, 95% CI 1.21-2.35). When only severe forms of PD were evaluated, a significant association was also observed (OR 2.98, 95% CI 1.58-5.62). Key Messages: In the present review, a significant association was observed between PD and AD. Further studies should be carried out in order to investigate the direction of the association and factors that may confound it.