Clinical Course of Oral Squamous Cell Carcinoma in Patients on Immunosuppressant and Glucocorticoid Therapy

Publication date: Available online 18 January 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Hideaki Hirai, Hirofumi Tomioka, Yumi Mochizuki, Yu Oikawa, Fumihiko Tsushima, Hiroyuki Harada
PurposeDepressed immune function is a serious adverse effect of long-term immunosuppressant and/or steroid administration at doses that exceed the physiologically required amount. The purpose of this study was to determine the effects of immunosuppression on carcinogenesis, particularly malignant tumor development, in patients with oral squamous cell carcinoma who were immunosuppressed because of immunosuppressant and/or steroid therapy administered for various underlying diseases.MethodsIn this retrospective chart review, 886 patients with oral squamous cell carcinoma were included who received treatment at our department between April 2001 and December 2011. Their clinical characteristics; tumor, node, metastasis (TNM) stage; initial treatment for the primary cancer; mode of cervical lymph node metastasis; incidence rate of distant metastases; white blood cell, neutrophil, and lymphocyte counts on initial examination; and therapeutic outcomes were evaluated and compared between patients on and not on immunosuppressant and/or steroid therapy. Survival rates were calculated using the Kaplan–Meier method.ResultsFourteen patients (5 men, 9 women; mean age, 65.2 years) were identified eligible who were on immunosuppressant and/or steroid therapy. They exhibited a significantly greater number of metastases, extracapsular spread, and distant metastases, of which, number of metastases and extracapsular spread were statistically significant (P = .0213, P = .042 respectively). In 9 patients, total lymphocyte count in the peripheral blood was ≤1,500/μL, indicating the lower limit of the normal range. One patient died as a result of recurrence of the primary tumor. Another patient died as a result of cervical lymph node recurrence. Distant metastases occurred in 2 patients. The cumulative disease-specific 5-year survival rate of patients receiving immunosuppressive therapy was 62.3% and that of patients with cervical lymph node metastasis was 25%.ConclusionThe results of this study suggest that patients with oral squamous cell carcinoma on immunosuppression show progression of cervical lymph node metastasis and extracapusular spread and are at a high risk of developing distant metastases.



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