Contents lists available at ScienceDirect Oral Oncology journal homepage: www.elsevier.com/locate/oraloncology Non-smoking, non-drinking elderly females, a 5 year follow-up of a clinically distinct cohort of oral squamous cell carcinoma patients Adrian DeAngelis e, ⁎ , Omar Breik e , Kendrick Koo f , Tim Iseli f , Alf Nastri e,g , Tsien Fua h , Danny Rischin i,j , Michael McCullough c,d , David Wiesenfeld a,b a Victorian Comprehensive Cancer Centre, Australia b Dept of Surgery, University of Melbourne, Australia c Melbourne Dental School, University of Melbourne, Australia d Royal Melbourne Hospital, Australia e Oral & Maxillofacial Surgery, Royal Melbourne Hospital, Australia f Otorhinolaryngology Head & Neck Surgery, Royal Melbourne Hospital, Australia g University of Melbourne, Australia h Dept of Radiation Oncology, Peter MacCallum Cancer Centre, Australia i Dept of Medical Oncology, Peter MacCallum Cancer Centre, Australia j Sir Peter MacCallum Dept of Oncology, University of Melbourne, Australia ARTICLE INFO Keywords: Squamous cell carcinoma Oral cancer Head and neck cancer Non-smoking Non-drinking Elderly females ABSTRACT Objectives To examine differences in survival and clinical outcomes of elderly patients without traditional risk factors presenting with oral squamous cell carcinoma. Materials & methods Retrospective review of 287 consecutive patients divided into 2 treatment period cohorts treated for oral SCC between the 1st Jan 2007 and 31st Dec 2012. Patients were classified as either smoker-drinkers (SD) or non- smoking, non-drinking (NSND). Only patients with oral sub-site primaries according to ICD-10 were included. Carcinomas of the lip, tonsil, base of tongue and oro-pharyngeal subsites were excluded. Results Of the study population (N = 287), 24.4% were NSND and 9.75% were NSND elderly (older than 70 years) females. > 50% of tumours arose from the oral tongue in NSND patients (p = 0.022) and there was a higher rate of recurrent and persistent disease (42.9% vs 27.6%, p = 0.005). Disease specific survival at 5 years was sig- nificantly reduced when NSND elderly females were compared to all other patients (p < 0.001) as well as age matched controls (p = 0.006). This effect was verified independently in each cohort. Conclusions The results of this study suggest that NSND elderly females are a distinct patient population with poorer disease specific survival outcomes. Introduction Head and neck cancers remain the 7th most commonly diagnosed cancer in Australia and 8th most common cancer worldwide re- presenting approximately 3% of all cancer cases diagnosed and 2% of all cancer related deaths [1–3]. Over 90% of oral and oro-pharyngeal malignancies are squamous cell carcinomas [3–5] and there are approximately 330 new cases of oral cavity cancer diagnosed each year in Victoria [6]. Tobacco use and alcohol intake are recognised risk factors for the development of oral squamous cell carcinoma (SCC) and individually are directly responsible for approximately 65–70% and 20–35% of oral malignancies respectively [7–9]. Alcohol consumption in combination with tobacco use has been shown to increase the risk of developing oral SCC by 8 to 15-fold [10–15]. https://doi.org/10.1016/j.oraloncology.2018.09.004 Received 7 August 2018; Received in revised form 2 September 2018; Accepted 5 September 2018 ⁎ Corresponding author. E-mail addresses: ADeAngelis1@gmail.com (A. DeAngelis), Tsien.Fua@petermac.org (T. Fua), Danny.Rischin@petermac.org (D. Rischin), m.mccullough@unimelb.edu.au (M. McCullough), David.Wiesenfeld@mh.org.au (D. Wiesenfeld). Oral Oncology 86 (2018) 113–120 1368-8375/ © 2018 Elsevier Ltd. All rights reserved. T