A prognostic model for oral squamous cell carcinoma patients with type 2 diabetes mellitus

Oral squamous cell carcinoma (OSCC), the most common type of oral cancer, accounts for 90% of all cancer types in oral cavity (Warnakulasuriya, 2009). In the past several years, new cases of oral cancer have been growing rapidly. According to the global cancer statistic, the number of new cases of 2020 is 22,849 more than that of 2018 (Bray et al., 2018; Sung et al., 2021). Patients diagnosed with early stage of OSCC usually experience a better 5-year survival rate (90%), while the 5-year survival rate of those diagnosed with later stage drops sharply to 30% (Omar, 2015). Researchers have developed many tools to predict the survival of OSCC patients. The most well-known one to us is the TNM staging system(Moeckelmann et al., 2018). According to the size of primary tumor, lymph node metastasis and distant metastasis, the prognosis of patients with OSCC can be preliminarily predicted. However, some other clinical factors can also affect the prognosis of patients with OSCC. Wang et al. constructed a prognostic model of OSCC based on clinicopathological data including age, sex, site, race, origin, grade, surgery, radiation and TNM stage (Wang et al., 2018). Nomograms of the model allowed clinicians to predict the long-term survival rate of OSCC patients more accurately.

Type 2 diabetes mellitus (T2DM), a complex chronic systemic disease, is charactered by insulin resistance and deficiency in insulin secretion, accounting for 95% diabetes mellitus patients(Xu et al., 2018). According to the prediction of the International Diabetes Federation (IDF), the population of diabetic patients will grow from 382 million in 2013–592 million in 2035 by 55% (Shi & Hu, 2014). T2DM is closely related to the occurrence and development of various oral diseases. It was reported that T2DM and periodontitis could promote each other, T2DM could increase the risk of periodontitis by 34%, and the prevalence of T2DM was significantly higher in periodontitis patients(Wu et al., 2020). Some infectious diseases, such as oral candidiasis, could also be secondary to uncontrolled T2DM(Sampath et al., 2019). Diabetes is also closely related to OSCC. Referring to the statistics of Xiangya Hospital in China, OSCC patients accompanying with T2DM account for 14.3% of all OSCC patients (Hu et al., 2020). Predictably, this proportion will continue to increase as the number of people with T2DM increases. In our previous study, type 2 diabetes mellitus (T2DM) was an independent risk factor for OSCC patients (Hu et al., 2020). Thus, OSCC patients with T2DM a special population with unique prognostic characteristics. However, up to now, there has not been a prognostic model for OSCC patients with T2DM.

In this study, we aimed to construct a model that could predict the prognosis of OSCC patients with T2DM. The model will allow clinicians to relatively accurately predict the prognosis of patients based on their clinical and pathological characteristics, thereby assisting in determining treatment plans.

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