Early-Stage Oral Squamous Cell Carcinoma in Adolescents and Young Adults Compared with Older Patients Exhibits Distinct Clinicopathological Features.
Summary
This retrospective study compared the clinicopathological features of stage I-II oral squamous cell carcinoma (OSCC) in adolescents and young adults (AYAs) versus older patients. OSCCs in AYAs are more frequently located on the tongue and exhibit distinct histological patterns, including an abnormal TP53 immunophenotype. Although AYAs demonstrate significantly better overall and disease-free survival, a depth of invasion (DOI) greater than 5 mm is a major prognostic indicator for distant metastasis and poorer survival within this group. Other factors such as clinical stage, tumor thickness, and tumor budding may also predict the risk of postoperative lymph node metastasis. Tested molecular markers did not provide robust prognostic stratification.
Analysis
The clinical analysis of this retrospective study highlights distinct features of early-stage OSCC in AYAs, suggesting a different disease course and prognosis compared to older patients. The most robust prognostic factor identified is a depth of invasion (DOI) > 5 mm, which is associated with an increased risk of distant metastasis and poorer survival in AYAs. Although the study is retrospective, these findings could justify prospective clinical trials to evaluate tailored management strategies for AYAs, potentially involving more intensive surveillance or adjuvant treatments for tumors with high DOI. The molecular markers tested (TP53, CDKN2A, MTAP) did not demonstrate robust prognostic value, indicating that clinical decisions should primarily rely on macroscopic and histological pathological features. Clinical impact could be seen in the medium term (3-5 years) if these observations are validated by prospective studies.