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Dr Syed Abdul Rauf Shah
Dr Gulmeena Masood
Dr Nadia Munir
Dr Faryal Gul
Dr Zeenia Arbab
Dr Aimen Mahmood Shah


Oral squamous cell carcinoma, smoking, p16



To assess the expression of p16 in different grades of OSCC to elucidate its prevalence and prognostic significance in this carcinoma type.


This prospective observational study investigated p16 expression in 69 cases of oral Squamous Cell Carcinoma spanning in multi centers including Teaching Hospitals of Bolan Medical College  / City  International Hospital Quetta, Pakistan and Ayub Medical College Abbotabad, Pakistan in the duration from October, 2022 to December, 2023. Formalin-fixed paraffin-embedded tissue blocks were utilized in the study for Hematoxylin and Eosin (H&E) staining and immunohistochemical (IHC) analysis, cases having inadequate formalin fixation and those receiving chemotherapy were excluded. Staining intensities and the proportion of stained cells were used to grade p16 expression; values ≥4 indicated positive. The indirect IHC method involved de-paraffinization, antigen retrieval, peroxidase blocking, and antibody incubation. Data analysis was done with SPSS (version:20.0) and involved Chi-square tests for categories related variables, with significance set at a p-value of <0.05.


The study analyzed 69 patients with Oral Squamous Cell Carcinoma (OSCC), predominantly male (66.7%), with an age range of 26 to 85 years, most commonly 61-70 years (43.5%). The tongue was the most frequent OSCC site (30.4%), followed by the buccal mucosa (26.1%). Well-differentiated OSCC was most prevalent (63.8%), followed by moderately (21.7%) and poorly differentiated cases (14.5%). p16 expression was positive in 72.5% of cases and negative in 27.5%. Among smokers, 72.5% were p16 positive; among snuff users, 73.7% were p16 positive; and among chewable tobacco users, 72.0% were p16 positive.


The tongue was the most frequently observed site for OSCC, with a predominance of well-differentiated lesions. Notably, there was a significant association between tobacco consumption (smoking & snuff usage) and p16 expression, even though there was no discernible relationship within p16 expression and OSCC grades. These findings emphasize the need to consider regional and demographic variations in OSCC research.

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