A Comprehensive Cross-Tabulation Analysis of Oral Carcinoma Patients: A Retrospective Study of Recent 7 Years.

BACKGROUND AND OBJECTIVES: According to the global cancer situation, which is very alarming, with over 10 million new diagnoses and more than 6 million deaths each year globally, cancer is one of the most prominent causes of morbidity and mortality today. One of the cancers is oral cancer. Oral cancer is the irregular development of malignant cells in the oral cavity. The study's objective was to decide the mortality of cross-tabulation among patients treated for oral carcinoma from Hospital Universiti Sains Malaysia (USM), Kelantan, Malaysia.
MATERIALS AND METHODS: This chapter summarizes the medical history for 7 years from January 2011 to December 2018 of patients who have been treated for oral carcinoma in the Hospital USM, Oral and Maxillofacial Surgery (OMFS) Unit. Each patient's complete medical record was checked, and data gathered were based on age, gender, site lesion, clinical diagnosis, and mortality. Version 26.0 of the SPSS software was used to evaluate the correlation and distribution of patient survival.
RESULTS: This was a retrospective cross-sectional review of the medical evidence of 117 patients infected for oral carcinoma at OMFS (Hospital USM). Sixty-seven (57.26%) of the patients were male and fifty (42.74%) were female. Patient age ranged from 25 to 93 years. Malay has the highest prevalence (85.5%) in oral carcinoma, followed by a second ethnic group, Chinese (7.7%). The result indicates that the majority of oral carcinoma patients were over 60 years old.Cases of oral squamous cell carcinoma have proved to be the most prevalent malignant tumour in the mouth cavity. The largest number of cases collected is 91% of the data collected. Mucoepidermoid carcinoma (10%) is the second most common small salivary gland tumor.
CONCLUSION: OSCC is the most prevalent kind of oral cancer. According to the data review, the most popular site for oral cancer is the tongue. Copyright:

INTRODUCTION

According to the global cancer scenario, cancer is one of the most prominent causes of morbidity and death today. It is very problematic, with more than 10 million new cases and more than 6 million deaths per year worldwide. About 20 million people are diagnosed with cancer worldwide, and more than half of cancer possibilities are in developed countries.[1] High-income countries have 2-fold of all deaths by cancer incidence as compared to low-income countries. Oral cancer is an abnormal growth in the oral cavity by malignant cells. Oral malignant growth was the sixth most common disease among Indian males. According to the National Cancer Registry in 2003, oral cancer was the third most common malignant development among Indian females in Malaysia, with 4.5% and 6.5%, respectively. In terms of gender, oral cancer was the 19th and 16th leading cancer in men and women, respectively. This is closely linked to the pattern of smoking cigarettes, betel quid chewing, and excessive alcohol intake. In the meantime, oral cancer in the 2007 National Cancer Registry study is the 21st most prevalent cancer in the general population. There were 353 recorded cases of oral cancer which affected 171 males and 182 females. Oral cancer is the third most common cancer among Malaysian Indians in Ministry of Health hospitals, according to the Malaysia Cancer Incidence survey. Heavy tobacco use, excessive alcohol consumption, a diet deficient in fruit and vegetables, betel nut chewing and poor oral hygiene, infection with sexually transmitted human papillomavirus (HPV) (especially type HPV 16), and sun exposure are the predisposing factors for oral cancer. Based on the studies, the survival rate of oral cancer in Australia was 83.3%, 55.6% in Taiwan, and 28.6% in Sao Paulo, Brazil.[2345] Meanwhile, Malaysia's 5-year survival rate was just 18.0%, much lower than in other research.[6]

The prevalence of age, gender, and ethnicity of oral cancer patients

According to a previous Ghazali et al. study, Kelantan's prevalence of oral cancer is 12.6%.[7] Oral cancer occurs mainly in the elderly. Warnakulasuriya has stated that the risk of contracting oral cancer increases with age, with most cases occurring in people 50 and over.[8] In the United States of America, the median age of diagnosis of oral cancer is 62 years old[9] and in Iraq was 60 years above age group.[10] However, the prevalence of oral cancer is growing in individuals under the age of 45 years.[8] Clinical research has found that oral cancer affected males by 1.6 times more compared to females.[7] The prevalence of males affected with oral cancer is 58.3% and of females is 41.7%.[11] This is due to exposure to lifestyle-related carcinogenic factors and dietary patterns, such as smoking, alcohol, and chewing betel nuts.[61213] In Malaysia, there are various ethnicities, such as Malays, Chinese, Indians, and others. Based on the previous study of oral cancer in Hospital Universiti Sains Malaysia (USM), the proportion of oral cancer cases for the Malays (82%), Chinese (6%), Indians (6%), and others (6%).[7]

The site of lesion of oral cancer

The location of the lesion depends on the prevailing risk factors. Tongue is the most common site of lesion in European and U. S. populations, which makes up about 40%–50% of oral cancer.[8] In the meantime, in Asian cultures, oral mucosa is more prevalent due to smoking and betel nut chewing.[8] In addition, in the Madrid analysis by Moreno-López et al., the most frequent location is also the tongue (34.7%), followed by the mouth floor (18.6%) and the labial mucosa (16%).[14] Furthermore, Prasan found that the tongue, followed by the cheek and mouth floor, was the most common position.[15] In addition, the most common causes of oral cancer are the tongue and oral mucosa.

The risk factors of oral cancer

The risk factors of oral cancer are multifactorial. The most important risk factors are tobacco use,[12141617] betel nut chewing,[17] and excessive alcohol intake.[111417] Other than that, poor oral hygiene[121417] and a terrible eating routine may likewise add to oral malignancy. Smoking was reported to be the most practiced habit in patients (60.2%), accompanied by betel nut chewing (18.2%) and alcohol intake (5.7%) in Hospital USM from January 2000 to December 2005.[16] Most patients in India consumed tobacco (88.5%), a danger factor in oral malignancy development.

The association of mortality with the site of lesion and tumor-node-metastasis stage of oral cancer

Age-adjusted oral cancer mortality rates have been estimated at 3–4 per 100,000 males and 1.5–2.0 per 100,000 females in most countries.[8] Based on the previous study (MohdKhairi et al., 2009), the mortality of the patients is significantly influenced by the site of the disease.[16] In the study reported, from 88 patients diagnosed with oral cancer, 11 (12.5%) died.[16] The highest number of deaths was associated with cancer of the palate (33%) and tonsils (33%), then followed by buccal mucosa (15.5%), tongue (14.8%), and salivary gland (4.2%).[16] The tumor-node-metastasis (TNM) score is used in comparing the severity of the disease as well as predicting the mortality rate of patients. There were 39 advanced cases (Stage III and IV) in the prior study, 9 (23.1%) of which died, while just 2 (4.7%) perished in the localized stage (Stage I and II).[16]

MATERIALS AND METHODS

The study was carried out retrospectively by examining the medical records of oral carcinomas in the Oral and Maxillofacial Surgery Unit, Hospital USM, Kelantan, Malaysia, from January 2011 to December 2018. The previous medical reports were carefully reviewed, collecting and recording the site of lesion in the oral cavity, risk factors, oral cancer histopathologically, stage of TNM, and mortality. Patient demographic profile was included, like age, ranging from 25 to 93 years, and was classified as <30, 30–39, 40–49, 50–59, >60, class, and ethnicity. The Statistical package for social sciences - version 23, Chicago, IL, USA has been used for the statistical analysis. The distribution of oral carcinoma sites among registered patients was assessed through a descriptive analysis and cross-tabulation analysis. Thirteen recorded lesion sites were included in this analysis. The reported locations were “tongue, buccal mucosa, palate, lip, mouth floor, salivary gland, mandible, maxilla, left alveolus of maxilla, left alveolus of mandible, right alveolus of mandible, left alveolar mucosa of mandible, right alveolar mucosa of mandible” tabulated by mortality status (survival or death) and pathology type (squamous cell carcinoma and mucoepidermoid carcinoma).

RESULTS

One hundred seventeen patients with 618 oral cancers were included in this retrospective study, of which 67 (57.26%) were male and 50 (42.74%) were female. The male-to-female ratio was about 1:1 [Figure 1]. Many patients come from a group that is over 60 years old. Figure 2 shows the prevalence of oral carcinoma according to ethnicity. Figure 3 displays the prevalence of oral carcinoma according to age group. The frequency of the most common sites of the lesion is shown in Figure 4.

Figure 1

Prevalence of oral carcinoma according to gender. 57.26% in blue represents the predominantly affected male, whereas 42.74% in red represents the affected female population

Figure 2

Prevalence of oral carcinoma according to ethnicity. 85.47% in blue represents the Malay ethnic, 7.69% Chinese, 1.71 Indians, and 5.13% others

Figure 3

Prevalence of oral carcinoma according to age group. 44.44% in age group >60 is the age group most afflicted with oral carcinoma

Figure 4

Frequency of the most common sites of the lesion. According to the obtained graph, tongue having the highest frequency, which is 54.70%, and the second highest is referred to salivary gland 11.97%

According to Table 1, the distribution of patient status within 7 years is being analyzed. Among the percentage of survival, there are 62.5% of patients with tongue lesion, and 37.5% have died. The second most common type of lesion is buccal mucosa; 61.5% of patients survived, while 38.5% died.

Table 1

Distribution of patient status within 7 years

Site of lesion	Mortality
	Survive, n (%)	Died, n (%)
Tongue	40 (62.5)	24 (37.5)
Buccal mucosa	8 (61.5)	5 (38.5)
Palate	7 (77.8)	2 (22.2)
Lip	2 (50.0)	2 (50.0)
FOM	2 (33.3)	4 (66.7)
SG	8 (57.1)	6 (42.9)
Mandible	8 (100.0)	-
Maxilla	1 (100.0)	-
Left alveolus of maxilla	1 (100.0)	-
Left alveolus of mandible	1 (100.0)	-
Left alveolar mucosa of mandible	1 (100.0)	-
Right alveolar mucosa of mandible	1 (100.0)	-
Right alveolus of mandible	1 (100.0)	-

SG: Salivary gland, FOM: Floor of mouth

The cross-tabulation of the pathology against the lesion site is shown in Table 2. According to Table 2, oral squamous cell carcinoma (OSCC) is the most common malignant epithelial neoplasm that affects the oral cavity. The vast majority of malignant epithelial neoplasms can be classified as squamous cell carcinoma, acinic cell carcinoma, mucoepidermoid carcinoma, and adenoid cystic carcinoma. The most common lesion site is in the tongue. The distribution between the pathology type and the position of the lesion is illustrated in Figure 5. Figure 5 indicates that the most common pathology in the oral cavity is squamous cell carcinoma.

Table 2

Cross-tabulation pathology site of lesion

Pathology	Site of lesion
	Tongue, n (%)	Buccal, n (%)	Palate, n (%)	Lip, n (%)	FOM, n (%)	SG, n (%)	Mandible, n (%)	Maxilla, n (%)	Total, n (%)
	Squamous cell carcinoma	62 (68.1)	12 (13.2)	4 (4.4)	3 (3.3)	4 (4.4)	1 (1.1)	5 (5.5)	-	91 (100.0)
Mucoepidermoid carcinoma	1 (10.0)	-	4 (40.0)	-	1 (10.0)	3 (30.0)	-	1 (10.0)	10 (100.0)
Adenoid cystic carcinoma	1 (11.1)	1 (11.1)	-	1 (11.1)	1 (11.1)	4 (44.4)	1 (11.1)	-	9 (100.0)
Acinic cell carcinoma	-	-	-	-	-	3 (100.0)	-	-	3 (100.0)
Others	-	-	1 (25.0)	-	-	3 (75.0)	-	-	4 (100.0)
Total	64 (54.7)	13 (11.1)	9 (7.7)	4 (3.4)	6 (5.1)	14 (12.0)	6 (5.1)	1 (0.9)	117 (100.0)

SG: Salivary gland, FOM: Floor of mouth

Figure 5

Biplot analysis for the pathology with the site of the lesion. It is indicated that squamous cell carcinoma is the pathology with the most occurrence among all sites of lesion

DISCUSSION

A few articles were published on the cross-tabulation analysis of oral carcinoma according to histopathological subtype with the specific site of the lesion. According to the study for 7 years of the patient records, the common sites are the buccal mucosa, tongue, and salivary gland. The most common pathology in the oral cavity is OSCC. In general, men are more likely to expose to the prevalence of oral cancer, which was about 57.26% compared to females (47.74%). This study discovered that the Malay ethnic group has a prevalence of 85.47%, the Chinese ethnic group has roughly 7.69%, Indians have 1.71%, and other ethnic groups have a 5.13%. From the analysis, it was found that patients above 51 years old are more exposed to oral cancer compared to other age groups. Based on previous studies in Malaysia, the mean age presentation of oral cancer was 59.1 years old,[7] 57.2 years old,[11] and 55.1 years old.[16] The result had shown that tongue constituted 54.70% and salivary gland was 14 (11.9%). Oral mucosa (54%), tongue (16.6%), gingival (14%), lip (6.6%), and hard palate (4.3%) were the most popular sites involved in India. Meanwhile, a study by MohdKhairi et al. stated tongue (30.7%), then salivary gland (27.3%), buccal mucosa (14.8%), and palate (10.2%) as the prevalent site.[16] Identical to the results in the study done by Chen et al. (2004), found that the tongue (42.8%), buccal mucosa (16%), gingiva (10.4%), and palate (10.1%).[4]

CONCLUSION

This paper examines the most common distribution of pathology type for oral carcinoma. According to the result, the highest case is from squamous cell carcinoma (77.78%), the second-highest type is mucoepidermoid carcinoma (8.55%), and the third in rank is adenoid cystic carcinoma (7.70%), followed by acinic cell carcinoma (2.56%) and others (3.42%). In 7 years of recorded data for oral carcinoma patients, the most frequent location for lesion is tongue 62 (68.1%), followed by salivary gland 14 (12%) and buccal mucosa 13 (11.1%). Among tongue cases, 40 (62.5%) cases are survived, and 24 (37.5%) have died. Biplot analysis [Figure 5] had shown that the sites of lip, mandible, buccal mucosa, and tongue are near to the squamous cell carcinoma. That means that most of the lip, mandible, buccal mucosa, and tongue involvement cases are cases originated from squamous cell carcinoma. Mucoepidermoid carcinoma mostly present near to palatal and maxilla bone which means carcinoma arises from these two sites are mostly mucoepidermoid carcinoma. The salivary gland is close to acinic cell carcinoma, which corresponds to acinic cell carcinoma being the most frequently discovered cancer type at the salivary gland.

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Conflicts of interest

There are no conflicts of interest.