Type of the Paper (Article Journal of Baghdad College of Dentistry, Vol. 34, No. 1 (2022), ISSN (P): 1817-1869, ISSN (E): 2311-5270 25 Research Article The effect of age on the clinicopathological features of oral squamous cell carcinoma Alaa S . Saeed1,* , Bashar H. Abdullah2 1 PHD Student, Ministry of Health / Al Sader Medical City , Al Najaf Al Ashraf ,Iraq. 2 Professor, Department of Oral and Maxillofacial pathology, College of Dentistry ,University of Baghdad . * Corresponding authors , drbashar69@yahoo.com Abstract: : Background: Squamous cell carcinoma is a disease of elderly peopleand it is uncommon in people with less than 40 years old; however many literatures revealed that tumor developing in patients younger than forty years appears more aggressive at the time of diagnosis. The purpose of the present study was to focus on the clincopathological features of the oral SCC in different age groups. Material and methods: In this study thirty five cases of paraffin embedded tissue blocks of oral squamous cell carcinoma were studied. The age range was from 16 to 80 years. The clinicopathological data were recorded for evaluating the tumor characters according to age of patients. Results : The age was not significantly correlated to the clinicopathological features that involved the gender of the patients, anatomical site of the tumor, perineural invasion , histological grading and staging . Keywords: Oral squamous cell carcinoma, age category, tumor behavior. . Introduction Oral SCC which is a multifactorial disease can be classified microscopically in to three grads including well differentiated, moderately differentiated and poorly differentiated tumor (1)As was reported in many literatures, a tumor developing in younger patients increased nowadays(2). However, the main etiological factors that have seen in elderly patients rarely occur in young individuals. Developing of this malignancy in the young patients mostly associated with different etiologies and different out comes (3). Hypothetically, a tumor developing in a young patients may be considered as a distinct clinical entity that needed more research and studies. This study intended to evaluate the clinicopathological features of the oral SCC among different age groups. Materials and Methods This retrospective study applied on thirty five case of paraffin embedded tissue blocks of oral SCC including twenty cases of patients with age >forty years and fifteen cases were patients with 0.05) in their demographic and clinical characteristics (Table-1). From a clinical point of view, patients younger than forty years demonstrated advanced stage more than elderly patients as stage III and IV were recorded for 76.9 % of young patients vs 46.7% for elderly patients ; however, this was not reach the statistical significant. Moreover, a slightly higher histological grading was recorded in young patients (33.3% a high grade) than elderly patients (15%) but this difference was non-significant as well. Table 1: Clinicopathological comparison of the study groups. Discussion. It is well known that adult people with smocking history are at a high risk for oral SCC development (4). Eventhough the fifths and the sevenths decade of the life are the usual age for oral SCC(5) , many researchers recorded increasing in the tumors incidence now a days below this age(6).This demographic changing in the tumor incidence is not well obvious because the long period of smocking habit (that have been seen in adults patients) is uncommon in young individuals. So, tobacco smocking may not be an important factor in the tumor development in young patients or it may be considered as a cofactor with other parameters such as viruses including HPV16 (7,8). Variables Age (year) p.value < 40 > 40 No. % No. % Gender Male 8 53.3 9 45.0 625 Female 7 46.7 11 55.0 Site Tongue 8 53.3 14 70.0 0.58 Floor 4 26.7 2 10.0 Buccal mucosa 1 6.7 2 10.0 Other 2 13.3 2 10.0 Grade Low grade 4 26.7 9 45.0 0.361 Intermediate grade 6 40.0 8 40.0 High grade 5 33.3 3 15.0 Stage Stage 1-2 3 23.1 8 53.3 0.102 Stage 3-4 10 76.9 7 46.7 Perineural Invasion Positive 3 20.0 5 25.0 0.727 Negative 12 80.0 15 75.0 J. Bagh. Coll. Dent. Vol. 34, No. 1. 2022 Saeed and Abdullah 27 Despite that, some authors showed poor tumor out- com and more aggressive behavior in the young individuals(9,10).Yet, the result of the studies still conflicting and many molecular markers and cell cycle proteins used as a prognostic indicators for the tumor behavior in the young and adult patients(11,12). In the present study, the samples were analyzed and studied as two age categories conidering the forty years was the limit value for the young participants. It should be noted that using such age as break point between the young and adult is common in the research since the tumor incidence is usually high above this age(4,7,13).The present study showed slightly a higher tumor incidence in females than in male patients as 51.4% in the females vs 48.5 % in the males which were in accordance with another study (14). However, males are the most commonly affected and this a slight difference may be related to the life style modification including smocking habits that recently increased among females (15). This study revealed that the most predominant affected anatomical site is the tongue in both age groups which was in accordance to previous Iraqi- study (16).With respect to the histological grading, there is no statistically significant difference in both age groups despite that young patients relatively associated with higher grade. This finding was mentioned by other studies (8,15,17). However, some authors suggested that low histological grading is more commonly seen in a young patients (4,18) . Clinical analysis of the present study revealed that advanced tumor stage was highly recorded for young patients in comparison to adult patients but it was statistically non significant. This finding was in agreement with other studies(17,19). on the other hand, that Shuwei et al. (2020) (20) in their study did not show any differences in TNM staging at the time of diagnosis between old and young patients . Advanced tumor stage in young patients might be due to delay in the tumor diagnosis or more aggressive tumor behavior. Moreover, when studying the perineural invasion at both age groups non significant difference was recorded. This finding was consistent with another studies (21,22) . Conclusion Statistically the age was not the main causative factor of the clinicopathological features of the tumor; however the subject was still controversy and large study sample with a molecular basis was required for better understanding of the biological behavior of oral SCC in different age groups. Conflict of interest : None References 1. Dascălu IT, Coleș E, Țîrcă T, et al. Histopathological aspects in oral Squamous cell carcinoma. J Dental Sci . 2018;3(2): 000173 2. Cassarino DS, DeRienzo DP, Barr RJ. Cutaneous squamous cell carcinoma: a comprehensive clinicopathological classification part one. J Cutan Pathol. 2006;33(3): 191-206. 3. Ribeiro AC, Silva AR, Simonato LE, et al. Clinical and histopathological analysis of oral squamous cell carcinoma in young people.BrJ.Oral Maxillofac. Surg.2009: 47(2) 95-98. 4. Muller S, Pan Y, Li R, et al. Changing trends in oral squamous cell carcinoma with particular reference to young patients: 1971–2006. The Emory University experience. 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Comparison of Squamous Cell Carcinoma of the Tongue Between Young and Old Patients, Seoul, Korea .J Patho Transl Med.2019;53(6). تاثير العمر على السمات السريرية المرضية لسرطان الفم الحرشفي العنوان: حي سعيد , بشار حامد عبد للا لباحثون: عالء صبا المستخلص حدوثه تحت سن اال ربعين .ولكن وفقا للعديد من الدراسات فان ظهور المرض لدى صغار السن وخصوصا اللذين التزيد اعمارهم الكبارو نادر ى شيوعا لد سرطان الفم الحرشفي اكثر على السمات المرضية للورم لدى فئات عمرية مختلفة عن االربعين يكون اكثر عدوانية ويرتبط بسلوك بايلوجي مختلف . الغرض من الدراسة هوتسليط الضوء عاما تم جمع البيانات لدراسة 80و 16عينة من انسجة سرطان الفم الحرشفي المطمورة بشمع البرافين وكانت اعمار المرضى تتراوح بين 35: اجريت الدراسة على اد وطرق العملالمو .ية السررية وفقا العمار المرضى السمات المرض .العصب حول والغزو مرحلة الورم ، النسيجي التصنيف ، الورم بموقع يتعلق فيما المقارنة المجموعات بين إحصائية داللة ذات فروق الحالية الدراسة تظهر لمالنتائج: عند للورم البايلوجي السللوك لتفسير المناعية المعلمات باستخدام جزئية دراسة الى يحتاج الموضوع. للورم والنسيجية السريرية الصفات تحديد في مؤثر غير عامل العمر: االستنتاجات . المختلفة العمرية الفئات