[Show abstract][Hide abstract] ABSTRACT: Background
The Neutrophil to lymphocyte ratio (NLR) has prognostic value in patients with a variety of cancers. However, its prognostic significance in oral squamous cell carcinoma (OSCC) patients has not been fully explored. The purpose of this study was to determine the clinical significance of NLR in patients with OSCC.
OSCC patients who underwent surgery following 5-fluorouracil (5-FU)-based chemoradiotherapy were enrolled in this study. The associations between the NLR status and various clinicopathological features were examined, and the effects of the NLR on the prognosis were evaluated. Analysis of circulating interleukin-6 (IL-6) was carried out and correlation with NLR and C-reactive protein concentration (CRP) was examined.
An elevated NLR was significantly correlated with advanced T-stage and poor response to chemoradiotherapy. Moreover, a Cox regression analysis based on the disease-free survival (DFS) revealed the NLR status (hazard ratio, 2.013; P = 0.041) and pathological response to chemoradiotherapy (hazard ratio, 0.226; P = 0.001) to be significant prognostic factors in OSCC patients. Furthermore, circulating IL-6 was found to correlate with NLR and CRP.
The NLR is a potential biomarker for predicting the clinical response to 5-FU-based chemoradiotherapy and the survival in OSCC patients, and the systemic inflammatory response may be potential target for improving patient’s prognosis.
Electronic supplementary material
The online version of this article (doi:10.1186/s12885-016-2079-6) contains supplementary material, which is available to authorized users.
[Show abstract][Hide abstract] ABSTRACT: Solitary plasmacytoma of bone is extremely rare in the jaw and most frequently arises in vertebrae and the skull. We report a case of solitary plasmacytoma arising in the mandible. A 67-year-old woman was referred to our hospital because of a slowly developing swelling in the right cheek. Intraoral examination disclosed a diffuse swelling in the right retromolar region. The patient did not have any pain or numbness. Panoramic radiography and computed tomography showed an osteolytic lesion measuring 20 × 15 mm in the right mandibular ramus. Laboratory analysis of the patient's blood and urine did not indicate any remarkable data. An incisional biopsy was performed with the patient under general anesthesia. The histopathological examination confirmed the diagnosis of plasmacytoma, predominantly IgA- λ type. Because there were no abnormal findings on bone marrow aspiration, the patient received local radiotherapy with a total dose of 50 Gy (in daily fractions of 2 Gy), and the tumor completely regressed. Seven years after radiotherapy, the patient is still alive without signs of recurrence or progression to multiple myeloma.
No preview · Article · Jan 2015 · Nippon Koku Geka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: We performed a clinico-statistical investigation of 73 patients who were diagnosed with minor intraoral salivary gland tumors at our department.The incidence of benign and malignant tumors was approximately equal. There were no statistically significant differences in the age or gender of the patients with benign or malignant tumors. Histologically, pleomorphic adenoma was the most common type of benign tumor, while mucoepidermoid carcinoma and adenoid cystic carcinoma were the major types of malignant tumor. The palate was the most common site. The retromolar region showed the highest incidence of malignant tumors.The diagnostic concordance rate was 87.1% in patients with malignant tumors. Almost all of the cases with diagnostic inconsistency involved the misdiagnosis of mucoepidermoid carcinoma as squamous cell carcinoma. These results suggested that clinicians must consider the possibility of intraoral minor salivary gland carcinoma in the diagnosis of intraoral tumors.All of the stage I, II and III tumors were surgically treated. In contrast, 75.0% of the stage IV tumor patients received combined pre-/postoperative radiotherapy and chemotherapy. The cumulative survival rates for all malignant tumor patients were 83.1% at 5 and 10 years. Stage IV malignant tumors were associated with a significantly poorer prognosis in comparison to the other groups. The patients with an advanced tumor stage or locoregional relapse and distant metastasis showed a worse prognosis. New therapeutic options, including particle beam therapy and molecular target drugs, should be investigated for to improve the treatment outcome of patients with malignant salivary gland tumors.
[Show abstract][Hide abstract] ABSTRACT: It has been increasingly recognized that the tumour microenvironment is a critical factor involved in cancer progression. However, little is known about the clinical value of the stromal features in oral squamous cell carcinoma (OSCC). The purpose of this study was to determine the clinical significance of cancer-associated fibroblasts (CAFs) and tumour-associated macrophages (TAMs) in OSCC. OSCC specimens were obtained from 60 patients who underwent surgery following 5-fluorouracil-based chemoradiotherapy. Paraffin-embedded sections obtained from biopsy specimens were immunohistochemically analysed. The associations among CAFs, TAMs and various clinicopathological features were examined, and the effects of CAFs and TAMs on the prognosis were evaluated. In the group with a high level of CAFs, the incidence of advanced pT- and pN-stage cases was significantly higher than that in the group with the low level. A high TAMs tumour expression was significantly correlated with a poor response to preoperative chemoradiotherapy. A Kaplan–Meier analysis revealed that higher numbers of CAFs and TAMs were significantly correlated with a poor prognosis. These findings suggest that TAMs are a potential biomarker for predicting the clinical response to 5-FU-based chemoradiotherapy, and the expression status of the CAFs and TAMs may be useful for making treatment decisions to improve the survival of OSCC patients.
[Show abstract][Hide abstract] ABSTRACT: Dormant or slow-cycling disseminated tumor cells (DTCs) in bone marrow (BM) are resistant to conventional therapy in various cancers including head and neck squamous cell carcinoma (HNSCC), although the molecular mechanisms remain largely unknown. This study aimed to identify the intrinsic molecular mechanisms underlying drug resistance in BM-DTCs. We used in vivo selection of the human HNSCC cell line HEp3, which mimics non-proliferative BM-DTCs in mice, to establish BM-DTC-derived (BM-HEp3) and lung metastases-derived (Lu-HEp3) sublines. Both sublines had higher migration activity and shortened survival in a murine xenograft model compared with parental (P-HEp3) cells. Slow-cycling BM-HEp3 cells had intrinsically enhanced cisplatin resistance compared with Lu-HEp3 cells, which also manifested this resistance but proliferated rapidly. The drug resistance and slow-cycling state of BM-HEp3 cells depended on enhanced positive feedback of the signaling axis of stromal cell-derived factor-1 (SDF-1)-C-X-C chemokine receptor-4 (CXCR4) via their overexpression. Interestingly, BM-DTCs highly expressed transforming growth factor-beta 2 (TGF-β2) to maintain SDF-1-CXCR4 overexpression. Inhibition of SDF-1-CXCR4 signaling by down-regulating TGF-β2 fully reversed the drug resistance of BM-HEp3 cells via reactivation of cell proliferation. These data suggest that the intrinsic TGF-β2-triggered SDF-1-CXCR4 signaling axis is crucial for drug resistance dependent on a slow-cycling state in BM-DTCs.
[Show abstract][Hide abstract] ABSTRACT: Purpose:
The peptides derived from ideal cancer-testis antigens, including LY6K, CDCA1, and IMP3 (identified using genome-wide cDNA microarray analyses), were used in immunotherapy for head and neck squamous cell cancer (HNSCC). In this trial, we analyzed the immune response to and safety and efficacy of vaccine therapy.
A total of 37 patients with advanced HNSCC were enrolled in this trial of peptide vaccine therapy, and the OS, PFS, and immunologic response were evaluated using enzyme-linked ImmunoSpot (ELISPOT) and pentamer assays. The peptides were subcutaneously administered weekly with IFA. The primary endpoints were evaluated on the basis of differences between HLA-A*2402-positive [A24(+)] patients treated with peptide vaccine therapy and -negative [A24(-)] patients treated without peptide vaccine therapy among those with advanced HNSCC.
Our cancer vaccine therapy was well tolerated. The OS of the A24(+) vaccinated group (n = 37) was statistically significantly longer than that of the A24(-) group (n = 18) and median survival time (MST) was 4.9 versus 3.5 months, respectively; P < 0.05. One of the patients exhibited a complete response. In the A24(+) vaccinated group, the ELISPOT assay identified LY6K-, CDCA1-, and IMP3-specific CTL responses in 85.7%, 64.3%, and 42.9% of the patients, respectively. The patients showing LY6K- and CDCA1-specific CTL responses demonstrated a longer OS than those without CTL induction. Moreover, the patients exhibiting CTL induction for multiple peptides demonstrated better clinical responses.
The immune response induced by this vaccine may improve the prognosis of patients with advanced HNSCC.
No preview · Article · Nov 2014 · Clinical Cancer Research
[Show abstract][Hide abstract] ABSTRACT: Adenomatoid odontogenic tumors (AOTs) are rare, benign odontogenic tumors characterized by a progressively slow growing pattern and asymptomatic behavior. The most common presentation is a cystic mass involving an unerupted tooth (especially canine), and the usual site is the anterior maxillary region. These tumors are histopathologically thought to arise from the odontogenic epithelium with or without inductive changes in the connective tissue. We herein report a rare case of AOT-like tumor arising in the first premolar region to the first molar region of the maxilla. A 33-year-old male was referred to our hospital for further evaluation of a round radiolucent lesion of the maxilla. After performing a biopsy, which confirmed the diagnosis of AOT, surgical excision was performed under general anesthesia. The tumor was encapsulated and relatively large (approximately 30 mm in maximal diameter) for an AOT. Furthermore, an unusual finding of the root resorption of adjacent teeth was observed. The histopathological examination showed duct-like structures composed of regularly single- or double-layered cuboidal cells; however, there were no duct-like structures composed of columnar epithelial cells characteristic of AOT. On the other hand, the existence of melanocytes, ghost cells, and CK19-positive cells suggests that our case was a benign odontogenic tumor. Taking all findings into account, we diagnosed this patient with an AOT-like, benign odontogenic tumor. The patient's postoperative course was uneventful, and no signs of recurrence have been found 2 years after the operation.
[Show abstract][Hide abstract] ABSTRACT: Kaposi's sarcoma (KS) is one of the most common diseases seen in patients presenting with acquired immunodeficiency syndrome (AIDS); however, it is rare in Japan. We herein report a case of AIDS-associated KS of the tongue, which was initially misdiagnosed as recurrent hemangioma according to the initial histopathological diagnosis. The patient is a 42-year-old male who had been suffering from a painful vascular neoplasm-like mass on the dorsum of the tongue. The patient did not complain of any other distinct symptoms and a debulking operation was planned based on the clinical diagnosis of hemangioma. However, preoperative blood tests revealed the presence of syphilis and the human immunodeficiency virus and the patient was therefore diagnosed to have full-blown AIDS. Therefore, the patient's oral lesion was then instead suspected to be oral KS (OKS). A histopathological examination of the tongue biopsy specimen showed the typical findings of KS. Combination active antiretroviral therapy (cART) combined with liposomal doxorubicin was administered and the patient achieved a complete remission (CR). In conclusion, clinicians including oral surgeons, should take OKS into account in the diagnosis of vascular neoplasm-like masses of the tongue in adults since this complication may occur as a result of AIDS.
[Show abstract][Hide abstract] ABSTRACT: The tumor-associated microenvironment has been shown to protect tumor cells from treatment, and the extracellular matrix (ECM) is known to affect drug resistance as a key regulator of the tumor microenvironment. However, little is known about cell adhesion-mediated drug resistance (CAM‑DR) due to cell-ECM contact in patients with oral squamous cell carcinoma (OSCC). In the present study, we evaluated the ECM molecule fibronectin (FN) using DNA microarray data obtained from parental and 5-FU-resistant OSCC cell lines. We investigated the effects of cell adhesion to FN on 5-FU resistance in OSCC cells and examined the activation of FN receptor β1 integrin‑mediated survival regulators such as ILK, Akt and NF-κB. In addition, we investigated whether FNIII14, a 22-mer peptide derived from FN that potently prevents β1 integrin-mediated adhesion to FN, could overcome CAM-DR against 5-FU in OSCC cells and examined the activation of survival regulators and apoptosis-related molecules. Consequently, we obtained the following results. FN was extracellularly overexpressed in the 5-FU-resistant cells compared with that observed in the 5-FU-sensitive cells. Cell adhesion to FN enhanced 5-FU resistance and activated integrin-mediated ILK/Akt/NF-κB survival signaling in the 5-FU-resistant OSCC cells. Furthermore, the inhibition of cell adhesion to FN by FNIII14 enhanced chemosensitivity to 5-FU and apoptosis by suppressing ILK/Akt/NF-κB signaling in the 5-FU-resistant cells. These novel findings demonstrate that FN is a potentially useful biomarker and therapeutic target for improving the treatment of OSCC, particularly in the setting of 5-FU resistance.
No preview · Article · Jan 2014 · International Journal of Oncology
[Show abstract][Hide abstract] ABSTRACT: The deregulation of microRNA (miRNA) is associated with multiple processes involved in cancer progression. RNase III endonucleases, Dicer and Drosha, are key enzymes for miRNA biogenesis, and it has been reported that altered expressions of these molecules affect the clinical outcomes of patients with various cancers. However, the clinical value of measuring the levels of Dicer and Drosha in oral squamous cell carcinoma (OSCC) patients is unclear. The purpose of this study was to determine the clinical significance of the expressions of Dicer and Drosha in patients with OSCC.
Oral squamous cell carcinoma specimens were obtained from 61 patients who underwent surgery following 5-fluorouracil-based chemoradiotherapy at Kumamoto University Hospital between October 2003 and January 2009. Paraffin-embedded sections obtained from biopsy specimens were immunohistochemically analyzed. The associations between Dicer, Drosha, and various clinicopathological features were examined, and the effects of Dicer and Drosha on the prognosis were evaluated.
A low Dicer tumor expression was significantly correlated with the pathological response to chemoradiotherapy. Furthermore, a Cox regression analysis based on the overall survival revealed the Dicer expression status (hazard ratio, 0.34; P = 0.048) and pathological response to chemoradiotherapy (hazard ratio, 0.21; P = 0.014) to be significant prognostic factors in OSCC patients. On the other hand, the Drosha expression was not associated with any clinicopathological features or the prognosis.
These results suggest that Dicer is a potential biomarker for predicting the clinical response to 5-FU-based chemoradiotherapy and the overall survival in patients with OSCC.
No preview · Article · Dec 2013 · Journal of Oral Pathology and Medicine
[Show abstract][Hide abstract] ABSTRACT: We report a rare case of giant cell tumor affecting the articular tubercle of the temporal bone. The patient was a 43-year-old woman who referred to our hospital with swelling of the left temporomandibular area and pain on opening her mouth. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a tumor mass involving the left mandibular ramus and condylar process, with bone destruction extending to the mandibular fossa. The mass was removed by gross total resection and curettage, and the defect was reconstructed by using mandibular reconstruction plates with condylar heads for the resected mandible bone. CT during follow-up showed that additional bone surrounded the titanium condylar head. During 12 years of clinical and radiological follow-up, the patient has manifested no evidence of recurrence. Masticatory function is well preserved, the maximum mouth opening is 32 mm, and the left artificial joint can move smoothly via a hinge movement of the mandible without ankylosis of the temporomandibular joint.
[Show abstract][Hide abstract] ABSTRACT: Neutrophil gelatinase-associated lipocalin (NGAL) is a member of the lipocalin superfamily. Although its overexpression in various cancers was reported, little is known about its expression and clinical significance in oral squamous cell carcinoma (OSCC). This study aimed to elucidate the clinical significance of NGAL in OSCC.
We immunohistochemically investigated NGAL expression in tumour cells and stromal cells in 96 OSCC tissues. NGAL expression in tumour cells significantly correlated with histological tumour cell differentiation, as shown by its specific distribution in the horn pearl-forming keratinized tumour cells, but not with other major clinicopathological parameters. We found NGAL(+) cells in the stroma that were predominantly myeloperoxidase-positive neutrophils. The number of such NGAL-expressing stromal cells was significantly associated with poor differentiation and reduced overall survival in OSCC. The prognostic value of stromal NGAL expression was significant in the univariate analysis while only a trend was found in the multivariate analyses.
This study is the first to show the clinical significance of stromal NGAL expression, which may be an indicator of poor prognosis and more aggressive histological grade in OSCC. Our data suggest that NGAL expression in tumour cells and stroma is associated in different ways with OSCC differentiation. This article is protected by copyright. All rights reserved.
[Show abstract][Hide abstract] ABSTRACT: Notch signaling has been reported to be involved in several types of malignant tumors; however, the role and activation mechanism of Notch signaling in oral squamous cell carcinoma (OSCC) remains poorly characterized. The purpose of this study was to elucidate the pathological significance of Notch signaling and its activation mechanism in the development and progression of OSCC. In this study, we showed that the expression of Notch1 and intracellular Notch domain (NICD) are upregulated in OSCCs. In addition, Notch1 and NICD were found to be characteristically localized at the invasive tumor front. TNF-α, a major inflammatory cytokine, significantly activated Notch signaling in vitro. In a clinicopathological analysis, Notch1 expression correlated with both the T-stage and the clinical stage. Furthermore, loss of Notch1 expression correlated with the inhibition of cell proliferation and TNF-α-dependent invasiveness in an OSCC cell line. In addition, γ-secretase inhibitor (GSI) prevented cell proliferation and TNF-α-dependent invasion of OSCC cells in vitro. These results indicate that altered expression of Notch1 is associated with increased cancer progression and that Notch1 regulates the steps involved in cell metastasis in OSCC. Moreover, inactivating Notch signaling with GSI could therefore be a useful approach for treating patients with OSCC.Laboratory Investigation advance online publication, 12 August 2013; doi:10.1038/labinvest.2013.95.
Full-text · Article · Aug 2013 · Laboratory Investigation
[Show abstract][Hide abstract] ABSTRACT: Inflammation has a role in the pathogenesis of atherosclerosis, which causes hypertension. Results from some studies have suggested links between periodontal disease and atherosclerosis, but links between periodontal disease and hypertension have been seldom studied. We investigated whether periodontal disease and serum antibody level were associated with hypertension. We studied 127 patients (93 men and 34 women, mean age 68±9 years) who were admitted with ischemic heart disease to our institution. A composite periodontal risk score was calculated from five periodontal vector scores. The levels of serum antibody against Porphyromonas gingivalis (Pg) were measured. Pulse pressure, mean blood pressure (BP) and pulse wave velocity were used as indices of atherosclerosis. We divided patients into two groups according to the levels of serum antibody against Pg: higher or equal to the median (high Pg antibody group) and lower than the median (low Pg antibody group).There was no difference in the use of antihypertensive agents between the two groups. The composite periodontal risk score (P=0.0003), systolic BP (P=0.030), diastolic BP (P=0.038), pulse pressure (P=0.050) and mean BP (P=0.055) were higher in the high Pg antibody group than in the low Pg antibody group. The composite periodontal risk score (r=0.320, P=0.0003), systolic BP (r=0.212, P=0.017), diastolic BP (r=0.188, P=0.035) and mean BP (r=0.225, P=0.011) correlated with the level of serum antibody against Pg, even after adjustment for age. An elevated antibody level against Pg indicates advanced periodontal disease and suggests advancement of atherosclerosis and hypertension.Hypertension Research advance online publication, 16 May 2013; doi:10.1038/hr.2013.46.
No preview · Article · May 2013 · Hypertension Research
[Show abstract][Hide abstract] ABSTRACT: Purpose
We evaluated whether preoperative chemotherapy with S-1 and concurrent radiotherapy is feasible and efficacious in the treatment of advanced oral squamous cell carcinoma.
Participants comprised 39 patients with oral carcinoma (stage III, n = 15; stage IVA, n = 24). All patients received a total radiation dose of 40 Gy, in once-daily 2-Gy fractions, and received S-1 at 65 mg/m2/day for 5 consecutive days, over 4 consecutive weeks with concurrent radiotherapy.
Hematological toxicity was mild and reversible. The most common non-hematological toxicity was grade 3 mucositis, but this was transient and tolerable. Radical surgery was performed for 37 patients, with the remaining 2 patients declining the surgery. Postoperatively, local failure developed in 1 patient, and neck failure in 2 patients. Distant metastases were identified in 4 patients. At a median follow-up of 38.0 months (range 23–88 months), locoregional control, disease-specific survival, and overall survival rates at 3 years were 91.5, 83.8, and 83.8 %, respectively.
Concurrent administration of S-1 and radiotherapy combined with surgery offers a well-tolerated method of successfully treating advanced oral squamous cell carcinoma. The locoregional control rate remains high even at 3 years of follow-up, and no serious adverse effects have been encountered.
Full-text · Article · Feb 2013 · Cancer Chemotherapy and Pharmacology