Chun-Ta Liao1, Yu-Wen Wen2, Shu Ru Lee2, Tsang-Wu Liu3, Sen-Tien Tsai4, Ming-Hsui Tsai5, Jin-Ching Lin6, Pei-Jen Lou7, Pen-Yuan Chu8, Yi-Shing Leu9, Kuo-Yang Tsai10, Shyuang-Der Terng11, Tsung-Ming Chen12, Cheng-Hsu Wang13, Chih-Yen Chien14, Wen-Cheng Chen15, Li-Yu Lee16, Chien-Yu Lin17, Hung-Ming Wang18, Shu-Hang Ng19, Chih-Hung Lin20, Tuan-Jen Fang1, Shiang-Fu Huang1, Chung-Jan Kang1, Kai-Ping Chang1, Lan Yan Yang21, Tzu-Chen Yen22. 1. Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. 2. Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan. 3. National Institute of Cancer Research, National Health Research Institutes, Miaoli County, Taiwan. 4. Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan. 5. Department of Otorhinolaryngology, Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan. 6. Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan. 7. Department of Otolaryngology, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan. 8. Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan. 9. Department of Otolaryngology, Mackay Memorial Hospital, Taipei, Taiwan. 10. Department of Oral and Maxillofacial Surgery, Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan. 11. Department of Head and Neck Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan. 12. Department of Otolaryngology-Head and Neck Surgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan. 13. Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan. 14. Department of Otolaryngology, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University, Taoyuan, Taiwan. 15. Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan. 16. Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. 17. Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. 18. Department of Medical Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. 19. Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. 20. Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. 21. Biostatistics and Informatics Unit, Clinical Trial Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. lyyang0111@gmail.com. 22. Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. yentc1110@gmail.com.
Abstract
BACKGROUND: The National Comprehensive Cancer Network guidelines recommend that patients with oral cavity squamous cell carcinoma (OSCC) and cT4b disease should be either included in clinical trials or treated with a nonsurgical approach. However, surgery may be feasible in selected patients with adequate safety margins. Using the nationwide Taiwanese Cancer Registry Database, we examined the prognosis of cT4b OSCC patients in relation to their treatment approach. METHODS: Of the 18,910 patients with previously untreated first primary OSCC identified between 2004 and 2010, 492 (2.6 %) had cT4b tumors. Of them, 327 (66 %) received initial treatment with surgery, whereas 165 (34 %) were initially treated with a nonsurgical approach. Of the latter group, 78 patients subsequently underwent surgery. A 5-year disease-specific survival (DSS) ≥45 % was considered as a favorable outcome. RESULTS: Better 5-year DSS and overall survival (OS) rates were observed in cT4b patients initially treated with surgery (vs. nonsurgery; DSS, 51 vs. 38 %; OS, 43 vs. 27 %, respectively, p < 0.001). Of the participants initially treated with surgery, patients with cN0-2 disease had better 5-year survival rates (DSS: cN0, 59 %; cN1, 53 %; cN2, 46 %; OS: cN0, 49 %; cN1, 50 %; cN2, 37 %) than those with cN3 disease (DSS: 0 %; OS: 0 %). Among cT4b patients who initially received a nonsurgical treatment, subjects who subsequently underwent surgery showed better outcomes. CONCLUSIONS: Primary surgery is performed in approximately two-thirds of cT4b OSCC patients, with cN0-2 cases showing a good prognosis. Patients who initially received a nonsurgical approach can subsequently be treated with surgery and achieve favorable outcomes.
BACKGROUND: The National Comprehensive Cancer Network guidelines recommend that patients with oral cavity squamous cell carcinoma (OSCC) and cT4b disease should be either included in clinical trials or treated with a nonsurgical approach. However, surgery may be feasible in selected patients with adequate safety margins. Using the nationwide Taiwanese Cancer Registry Database, we examined the prognosis of cT4b OSCC patients in relation to their treatment approach. METHODS: Of the 18,910 patients with previously untreated first primary OSCC identified between 2004 and 2010, 492 (2.6 %) had cT4b tumors. Of them, 327 (66 %) received initial treatment with surgery, whereas 165 (34 %) were initially treated with a nonsurgical approach. Of the latter group, 78 patients subsequently underwent surgery. A 5-year disease-specific survival (DSS) ≥45 % was considered as a favorable outcome. RESULTS: Better 5-year DSS and overall survival (OS) rates were observed in cT4b patients initially treated with surgery (vs. nonsurgery; DSS, 51 vs. 38 %; OS, 43 vs. 27 %, respectively, p < 0.001). Of the participants initially treated with surgery, patients with cN0-2 disease had better 5-year survival rates (DSS: cN0, 59 %; cN1, 53 %; cN2, 46 %; OS: cN0, 49 %; cN1, 50 %; cN2, 37 %) than those with cN3 disease (DSS: 0 %; OS: 0 %). Among cT4b patients who initially received a nonsurgical treatment, subjects who subsequently underwent surgery showed better outcomes. CONCLUSIONS: Primary surgery is performed in approximately two-thirds of cT4b OSCC patients, with cN0-2 cases showing a good prognosis. Patients who initially received a nonsurgical approach can subsequently be treated with surgery and achieve favorable outcomes.