Aim: To compare various parameters associated with oral cancer in young and old patients and systematically compile the data on prognosis or outcome of oral cancer in young and old patients that include case series, matched-pair analyses, institutional series, and database reviews. Background: Though oral cancer is considered a disease of old age, a recent clinical scenario witnesses its increasing incidence among young persons. When compared to old patients, young patients with oral cancer are exposed to the carcinogens for a very petite period of time suggesting underlying pathogenesis to be distinct from that in older individuals. Literature reports several studies about the occurrence of oral cancer in young patients; however, no unanimous opinion exists about its prognosis and treatment outcomes when compared to older patients. Keeping this in mind, we have extensively studied all the possible aspects (location, local and regional recurrence, nodal and distant metastasis, overall survival, etc.) from the English literature and systematically compiled the available data on prognosis or outcomes of oral cancer. Review results: The overall outcome of the case series shows poorer prognosis in young patients, matched-pair analyses, and institutional series suggesting no significant differences whereas the databases favored a better prognosis in young patients. The mean overall survival rate was found to be better for young patients in the database and institutional review whereas worse in the matched-pair analyses. The mean 5-year survival rate was found to be more in young individuals in matched-pair analyses, database reviews, and institutional series as compared to older oral cancer patients. Conclusion: Though data extracted from various study designs are heterogeneous, the present review gives a scoping view of the papers published on oral cancer in young vs old patients. More prospective studies are suggested with a larger sample size in the future. Clinical significance: The present review will help to better understand the nature, course, and biologic behavior of oral cancer in young patients leading to the development of specific treatment strategies to manage the patients based on their age-groups.
Dos Santos Costa SF, Brennan PA, Gomez RS, et al. Molecular basis of oral squamous cell carcinoma in young patients: is it any different from older patients? J Oral Pathol Med 2018;47(6):541–546. DOI: 10.1111/jop.12642.
Jemal A, Clegg LX, Ward E, et al. Annual report to the nation on the status of cancer, 1975–2001, with a special feature regarding survival. Cancer 2004;101(1):3–27. DOI: 10.1002/cncr.20288.
Curado MP, Johnson NW, Kerr AR, et al. Oral and oropharynx cancer in South America: incidence, mortality trends and gaps in public databases as presented to the Global Oral Cancer Forum. Transl Res Oral Oncol 2016;1:1–7. DOI: 10.1177/2057178X16653761.
Santos-Silva AR, Ribeiro AC, Soubhia AM, et al. High incidences of DNA ploidy abnormalities in tongue squamous cell carcinoma of young patients: an international collaborative study. Histopathology 2011;58(7):1127–1135. DOI: 10.1111/j.1365-2559.2011.03863.x.
Adduri R Sr, Kotapalli V, Gupta NA, et al. P53 nuclear stabilization is associated with FHIT loss and younger age of onset in squamous cellcarcinoma of oral tongue. BMC Clin Pathol 2014;14:37. DOI: 10.1186/1472-6890-14-37.
van Monsjou HS, Lopez-Yurda MI, Hauptmann M, et al. Oral and oropharyngeal squamous cell carcinoma in young patients: the Netherlands Cancer Institute experience. Head Neck 2013;35(1):94–102. DOI: 10.1002/hed.22935.
Miranda Galvis M, Santos-Silva AR, Freitas Jardim J, et al. Different patterns of expression of cell cycle control and local invasion-related proteins in oral squamous cell carcinoma affecting young patients. J Oral Pathol Med 2018;47(1):32–39. DOI: 10.1111/jop.12601.
Amsterdam JT, Strawitz JG. Squamous cell carcinoma of the oral cavity in young adults. J Surg Oncol 1982;19(2):65–68. DOI: 10.1002/jso.2930190202.
McGregor GI, Davis N, Robins RE. Squamous cell carcinoma of the tongue and lower oral cavity in patients under 40 years of age. Am J Surg 1983;146(1):88–92. DOI: 10.1016/0002-9610(83)90265-9.
Newman AN, Rice DH, Ossoff RH, et al. Carcinoma of the tongue in persons younger than 30 years of age. Arch Otolaryngol 1983;109(5):302–304. DOI: 10.1001/archotol.1983.00800190024006.
Son YH, Kapp DS. Oral cavity and oropharyngeal cancer in a younger population. Review of literature and experience at Yale. Cancer 1985;55(2):441–444. DOI: 10.1002/1097-0142(19850115)55:2<441::aidcncr2820550225> 3.0.co;2-5.
McGregor AD, Rennie JS. Intra-oral squamous cell carcinoma in patients under 40 years of age. A report of 13 cases and review of the literature. Br J Plast Surg 1987;40(3):270–273. DOI: 10.1016/0007- 1226(87)90121-4.
Benninger MS, Roberts JK, Levine HL, et al. Squamous cell carcinoma of the head and neck in patients 40 years of age and younger. Laryngoscope 1988;98(5):531–534. DOI: 10.1288/00005537- 198805000-00011.
Cusumano RJ, Persky MS. Squamous cell carcinoma of the oral cavity and oropharynx in young adults. Head Neck Surg 1988;10(4):229–234. DOI: 10.1002/j.1930-2398.1988.tb00004.x.
Venables CW, Craft IL. Carcinoma of the tongue in early adult life. Br J Cancer 1967;21(4):645–650. DOI: 10.1038/bjc.1967.75.
Byers RM. Squamous cell carcinoma of the oral tongue in patients less than thirty years of age. Am J Surg 1975;130(4):475–478. DOI: 10.1016/0002-9610(75)90487-0.
Iype EM, Pandey M, Mathew A, et al. Squamous Cell Carcinoma of the Tongue Among Young Indian Adults. Neoplasia 2001;3(4):273–277. DOI: 10.1038/sj.neo.7900172.
Sarkaria JN, Harari PM. Oral tongue cancer in young adults less than 40 years of age: rationale for aggressive therapy. Head Neck 1994;16(2):107–111. DOI: 10.1002/hed.2880160202.
Atula S, Grénman R, Laippala P, et al. Cancer of the tongue in patients younger than 40 years. A distinct entity? Arch Otolaryngol Head Neck Surg 1996;122(12):1313–1319. DOI: 10.1001/archotol.1996.01890240021006.
Martin-Granizo R, Rodriguez-Campo F, Naval L, et al. Squamous cell carcinoma of the oral cavity in patients younger than 40 years. Otolaryngol Head Neck Surg 1997;117(3 Pt 1):268–275. DOI: 10.1016/s0194-5998(97)70185-2.
Hart AK, Karakla DW, Pitman KT, et al. Oral and oropharyngeal squamous cell carcinoma in young adults: a report on 13 cases and review of the literature. Otolaryngol Head Neck Surg 1999;120(6):828–833. DOI: 10.1016/S0194-5998(99)70322-0.
Popovtzer A, Shpitzer T, Bahar G, et al. Squamous cell carcinoma of the oral tongue in young patients. Laryngoscope 2004;114(5):915–917. DOI: 10.1097/00005537-200405000-00025.
Pytynia KB, Grant JR, Etzel CJ, et al. Matched analysis of survival in patients with squamous cell carcinoma of the head and neck diagnosed before and after 40 years of age. Arch Otolaryngol Head Neck Surg 2004;130(7):869–873. DOI: 10.1001/archotol.130.7.869.
Sasaki T, Moles DR, Imai Y, et al. Clinico-pathological features of squamous cell carcinoma of the oral cavity in patients <40 years of age. J Oral Pathol Med 2005 Mar;34(3):129–133. DOI: 10.1111/j.1600- 0714.2004.00291.x.
Garavello W, Spreafico R, Gaini RM. Oral tongue cancer in young patients: a matched analysis. Oral Oncol 2007;43(9):894–897. DOI: 10.1016/j.oraloncology.2006.10.013.
Lee CC, Ho HC, Chen HL, et al. Squamous cell carcinoma of the oral tongue in young patients: a matched-pair analysis. Acta Otolaryngol 2007;127(11):1214–1217. DOI: 10.1080/00016480701230910.
Ho HC, Lee MS, Hsiao SH, et al. Squamous cell carcinoma of the oral cavity in young patients: a matched-pair analysis. Eur Arch Otorhinolaryngol 2008;265(Suppl. 1):S57–S61. DOI: 10.1007/s00405- 007-0496-5.
Kaminagakura E, Vartanian JG, da Silva SD, et al. Case-control study on prognostic factors in oral squamous cell carcinoma in young patients. Head Neck 2010;32(11):1460–1466. DOI: 10.1002/hed.21347.
Park JO, Sun DIl, Cho KJ, et al. Clinical outcome of squamous cell carcinoma of the tongue in young patients: a stage-matched comparative analysis. Clin Exp Otorhinolaryngol 2010 Sep;3(3):161–165. DOI: 10.3342/ceo.2010.3.3.161.
Keegan TH, Ries LA, Barr RD, et al. Comparison of cancer survival trends in the United States of adolescents and young adults with those in children and older adults. Cancer 2016;122(7):1009–1016. DOI: 10.1002/cncr.29869.
Jeon JH, Kim MG, Park JY, et al. Analysis of the outcome of young age tongue squamous cell carcinoma. Maxillofac Plast Reconstr Surg 2017;39(1):41. DOI: 10.1186/s40902-017-0139-8.
Kuriakose M, Sankaranarayanan M, Nair MK, et al. Comparison of oral squamous cell carcinoma in younger and older patients in India. Eur J Cancer B Oral Oncol 1992;28B(2):113–120. DOI: 10.1016/0964- 1955(92)90038-3.
Lipkin A, Miller RH, Woodson GE. Squamous cell carcinoma of the oral cavity, pharynx, and larynx in young adults. Laryngoscope 1985 Jul;95(7 Pt 1):790–793. DOI: 10.1288/00005537-198507000- 00008.
Schantz SP, Byers RM, Goepfert H, et al. The implication of tobacco use in the young adult with head and neck cancer. Cancer 1988;62(7):1374–1380. DOI: 10.1002/1097-0142(19881001)62:7<1374::aidcncr2820620723> 3.0.co;2-m.
Friedlander PL, Schantz SP, Shaha AR, et al. Squamous cell carcinoma of the tongue in young patients: a matched-pair analysis. Head Neck 1998;20(5):363–368. DOI: 10.1002/(sici)1097- 0347(199808)20:5<363::aid-hed1>3.0.co;2-w.
Verschuur HP, Irish JC, O’Sullivan B, et al. A matched control study of treatment outcome in young patients with squamous cell carcinoma of the head and neck. Laryngoscope 1999;109(2 Pt 1):249–258. DOI: 10.1097/00005537-199902000-00015.
Vargas H, Pitman KT, Johnson JT, et al. More aggressive behavior of squamous cell carcinoma of the anterior tongue in young women. Laryngoscope 2000;110(10 Pt 1):1623–1626. DOI: 10.1097/00005537- 200010000-00009.
Morris LG, Ganly I. Outcomes of oral cavity squamous cell carcinoma in pediatric patients. Oral Oncol 2010;46(4):292–296. DOI: 10.1016/j. oraloncology.2010.01.015.
Funk GF, Karnell LH, Robinson RA, et al. Presentation, treatment, and outcome of oral cavity cancer: a National Cancer Data Base report. Head Neck 2002;24(2):165–180. DOI: 10.1002/hed.10004.
Lacy PD, Piccirillo JF, Merritt MG, et al. Head and neck squamous cell carcinoma: better to be young. Otolaryngol Head Neck Surg 2000;122(2):253–258. DOI: 10.1016/S0194-5998(00)70249-X.
Annertz K, Anderson H, Biörklund A, et al. Incidence and survival of squamous cell carcinoma of the tongue in Scandinavia, with special reference to young adults. Int J Cancer 2002;101(1):95–99. DOI: 10.1002/ijc.10577.
Schantz SP, Yu GP. Head and neck cancer incidence trends in young Americans, 1973–1997, with a special analysis for tongue cancer. Arch Otolaryngol Head Neck Surg 2002;128(3):268–274. DOI: 10.1001/archotol.128.3.268.
Soudry E, Preis M, Hod R, et al. Squamous cell carcinoma of the oral tongue in patients younger than 30 years: clinicopathologic features and outcome. Clin Otolaryngol 2010;35(4):307–312. DOI: 10.1111/j.1749-4486.2010.02164.x.
Vermund H, Brennhovd IO, Harvei S, et al. Carcinoma of the tongue in Norway and Wisconsin. I. Incidence and prognosis related to sex and age. Acta Radiol Oncol 1982;21(3):155–168. DOI: 10.3109/02841868209134000.
von Doersten PG, Cruz RM, Rasgon BM, et al. Relation between age and head and neck cancer recurrence after surgery: a multivariate analysis. Otolaryngol Head Neck Surg 1995;113(3):197–203. DOI: 10.1016/S0194-5998(95)70106-0.
Hyam DM, Conway RC, Sathiyaseelan Y, et al. Tongue cancer: do patients younger than 40 do worse? Aust Dent J 2003;48(1):50–54. DOI: 10.1111/j.1834-7819.2003.tb00009.x.
Veness MJ, Morgan GJ, Sathiyaseelan Y, et al. Anterior tongue cancer: age is not a predictor of outcome and should not alter treatment. ANZ J Surg 2003;73(11):899–904. DOI: 10.1046/j.1445- 2197.2003.02818.x.
Liao CT, Wang HM, Hsieh LL, et al. Higher distant failure in young age tongue cancer patients. Oral Oncol 2006 Aug;42(7):718–725. DOI: 10.1016/j.oraloncology.2005.11.012.
Udeabor SE, Rana M, Wegener G, et al. Squamous cell carcinoma of the oral cavity and the oropharynx in patients less than 40 years of age: a 20-year analysis. Head Neck Oncol 2012;4:28. DOI: 10.1186/1758- 3284-4-28.
Fang QG, Shi S, Liu FY, et al. Tongue squamous cell carcinoma as a possible distinct entity in patients under 40 years old. Oncol Lett 2014 Jun;7(6):2099–2102. DOI: 10.3892/ol.2014.2054.
Siegelmann-Danieli N, Hanlon A, Ridge JA, et al. Oral tongue cancer in patients less than 45 years old: institutional experience and comparison with older patients. J Clin Oncol 1998;16(2):745–753. DOI: 10.1200/JCO.19126.96.36.1995.
Chang TS, Chang CM, Ho HC, et al. Impact of young age on the prognosis for oral cancer: a population-based study in Taiwan. PLoS One 2013;8(9):e75855. DOI: 10.1371/journal.pone.0075855.
Lingen MW, Chang KW, McMurray SJ, et al. Overexpression of p53 in squamous cell carcinoma of the tongue in young patients with no known risk factors is not associated with mutations in exons 5–9. Head Neck 2000;22(4):328–335. DOI: 10.1002/1097-0347(200007)22:4<328::aid-hed3>3.0.co;2-r.
Schantz SP, Hsu TC, Ainslie N, et al. Young adults with head and neck cancer express increased susceptibility to mutagen-induced chromosome damage. JAMA 1989 15;262(23):3313–3315. DOI: 10.1001/jama.1989.03430230098033.
Zheng Y, Shen H, Sturgis EM, et al. Cyclin D1 polymorphism and risk for squamous cell carcinoma of the head and neck: a casecontrol study. Carcinogenesis 2001;22(8):1195–1199. DOI: 10.1093/carcin/22.8.1195.
Thomas L, Moore EJ, McGree ME, et al. Prognostic features, human papillomavirus status, and epidermal growth factor receptor expression in oral squamous cell carcinoma in young adults. Am J Otolaryngol 2012;33(6):650–656. DOI: 10.1016/j. amjoto.2012.01.009.