Does young age adversely affect prognosis for oral squamous cell carcinoma?
Background: Squamous cell carcinoma in young patients (<40 years of age) is believed to have an etiology that is distinct from squamous cell cancer in older patients because these patients have had less exposure to risk factors such as tobacco and alcohol use. Younger patients were historically believed to have a more aggressive disease with poorer outcomes, but recent analyses have shown equivalent survival with equivalent appropriate therapy. Little is known about survival and prognosis of oral squamous cell carcinoma patients in the pediatric population.
Study design: Retrospective chart review of pediatric patients (defined as age less than or equal to 20 years) with squamous cell carcinoma of the oral tongue treated from 1983 to 2009. Adult patients with squamous cell carcinoma of the oral tongue were matched to the pediatric group by sex, tobacco exposure, tumor, nodal and metastasis stage and treatment.
Setting: Memorial Sloan-Kettering Cancer Center
Synopsis: Ten pediatric and 40 adult patients met the study criteria. After matching, there were no significant differences between pediatric and adult patients with respect to histologic features such as depth of invasion, grade, margin status, perineural invasion, vascular invasion or the use of adjuvant therapy. One pediatric patient had a history of tobacco use (11 percent) compared to 18 matched adult patients (53 percent); however, this difference did not achieve significance. Only one pediatric patient had a history of Fanconi anemia, a genetic disorder associated with an increased risk of oral cancer. Overall survival (70 percent for pediatric patients, 64 percent for adults), disease-specific survival (80 percent for pediatric patients, 76 percent for adults) and recurrence-free survival (70 percent for pediatric patients, 78 percent for adults) did not significantly differ.
Bottom line: Although this study is limited by a small number of pediatric patients, it demonstrates comparable survival rates for pediatric and adult patients with oral tongue squamous cell cancer when equivalent treatment is administered.
Citation: Morris LG, Patel SG, Shah JP, et al. Squamous cell carcinoma of the oral tongue in the pediatric age group. Arch Otolaryngol Head Neck Surg. 2010;136(7):697-701.
—Reviewed by Christine G. Gourin, MD, FACS