Cancer of the tongue in patients younger than 40 years. A distinct entity?

BACKGROUND: An increase in the incidence of oral cancer among patients younger than 40 years has been reported worldwide. It has been suggested that the disease behaves more aggressively among young people.

OBJECTIVE: To evaluate the clinical and biologic behavior of tongue cancer among younger patients.

PATIENTS AND METHODS: Data on all patients younger than 40 years in whom tongue cancer was diagnosed in Finland between 1980 and 1989 (34 cases) were collected; pertinent clinical data were available for risk factor screening. A follow-up of at least 5 years or until death was available for all 34 patients. Immunocytochemical staining techniques were used to assess the expression of p53 and bcl-2 proteins, and p53 mutation analysis was performed by using the nonradioactive single-strand conformation polymorphism technique.

RESULTS: The incidence of tongue cancer in this age group in Finland did not change during the study period. The clinical behavior of tongue cancer in young people was not more aggressive compared with that of older patients in general, with the overall 5-year survival being as good as 70.6%. Altogether, p53 mutations were found in 17 of 33 tumors (51.5%). The p53 and bcl-2 protein expression was strong or moderate in 33.3% and 30.3% of the samples, respectively. Intense p53 protein expression was associated with the larger tumor size (P < .05). The poorest prognosis was found in patients with tumors greater than 4 cm in diameter (P = .01) or moderately or poorly differentiated cancer (P = .01). There was a trend for the adverse prognosis to accumulate in patients with moderately or poorly differentiated carcinoma and mutations in p53 (P = .09).

CONCLUSIONS: The cause of tongue cancer in patients younger than 40 years seems to be multifactorial. Those patients had a similar clinical course, prognosis, and function of p53 as found in the reports of a normal age variation. Mutations of p53 seemed to be an additional prognostic marker that was associated with moderate or poor differentiation of the tumors.