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Analysis of risk factors for multiple primary oral squamous cell carcinoma: a cohort study

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Abstract

Objective

Chewing betel quid (CBQ) is popular in Southeast Asia, resulting in a high incidence of oral squamous cell carcinoma (OSCC). The incidence of multiple primary oral cancer (MPOC) has gradually increased and has become one of the main causes of OSCC treatment failure. However, it is unclear whether the high incidence of MPOC is also correlated with the habit of CBQ.

Materials and methods

In this retrospective study, 915 OSCC patients were enrolled. MPOC incidence and characteristics were analyzed. CBQ and other risk factors for MPOC were investigated by chi-squared test and logistic stepwise regression analysis.

Results

Among 915 patients, 15 were diagnosed with synchronous MPOC. After follow-up, 60 of 915 patients developed a second or third primary lesion site and were diagnosed with metachronous MPOC. The remaining 840 patients were then diagnosed with single primary oral cancer (SPOC). The cumulative incidence of MPOC in all OSCC patients was 8.2%. CBQ and the related oral submucous fibrosis (OSF) were found to be independent risk factors of MPOC (P < 0.001). Both MPOC and SPOC patients with a CBQ habit were much younger than those who did not have a CBQ habit (P < 0.001). The buccal mucosa was the most common primary occurrence site (35.9%) in MPOC cases, and almost all MPOC patients with buccal cancer had previously suffered from OSF (88.9%).

Conclusion

CBQ and CBQ-related OSF, for the first time, are identified as the independent risk factors of MPOC. Prevention and treatment of OSF as well as cessation of CBQ are expected to become new approaches to reduce the incidence of MPOC.

Clinical relevance

More frequent physical examinations should be undertaken in OSCC patients with CBQ or CBQ-related OSF.

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Acknowledgments

The authors would like to thank all patients, nurses, and medical staff at the Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University. We also thank H. Nikki March, PhD, from Liwen Bianji, Edanz Editing China (www.liwenbianji.cn/ac), for editing the English text of a draft of this manuscript.

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Correspondence to Canhua Jiang.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and the 1964 Helsinki declaration and its later amendments. This study was approved by the Ethics Committee of Xiangya Hospital, Central of Central South University (No. 2012016). The institutional and/or licensing committee approves the experiment, including any relevant details.

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Xiaoyu Lin and Xiaoshan Wu are Co-first authors

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Lin, X., Wu, X., Gomaa, A. et al. Analysis of risk factors for multiple primary oral squamous cell carcinoma: a cohort study. Clin Oral Invest 24, 3147–3155 (2020). https://doi.org/10.1007/s00784-019-03189-0

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