Wen-Chi Liu1, Hsueh-Erh Liu2, Yi-Wei Kao3, Lei Qin4, Kuan-Chou Lin5, Chih-Yuan Fang5, Lo-Lin Tsai5, Ben-Chang Shia6, Szu-Yuan Wu7. 1. Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan; Department of Cancer Center, Taipei Medical University Hospital, Taipei, Taiwan. 2. Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan. 3. Graduate Institute of Business Administration, Fu Jen Catholic University, Taipei, Taiwan. 4. School of Statistics, University of International Business and Economics, Beijing, China. 5. Division of Oral and Maxillofacial Surgery, Department of Dentistry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan. 6. Research Center of Big Data, College of Management, Taipei Medical University, Taipei, Taiwan; College of Management, Taipei Medical University, Taipei, Taiwan; Executive Master Program of Business Administration in Biotechnology, College of Management, Taipei Medical University, Taipei, Taiwan. 7. Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan. Electronic address: szuyuanwu5399@gmail.com.
Abstract
PURPOSE: Although patients aged >70 years are subject to early oral cavity squamous cell carcinoma (E-OCSCC), evidence is currently lacking regarding the probable outcomes of definitive radiotherapy (RT) compared to surgery in this population. METHODS: We recruited patients aged ≥70 years with a diagnosis of E-OCSCC from the Taiwan Cancer Registry Database. Propensity score matching was performed, and Cox proportional-hazards model curves were used to analyze all-cause mortality of patients at different age intervals undergoing different treatments. RESULTS: The matching process yielded a final cohort of 604 patients in the definitive RT and surgery cohorts who were eligible for further analysis. These patients were classified as old (70-80 years) and very old (>80 years). In the multivariate Cox regression analysis, the adjusted hazard ratio (aHR) (95% confidence interval [CI]) for surgery compared with definitive RT was 0.465 (0.354-0.610, P < 0.001). The aHR (95% CI) for age >80 years compared with age 70-80 years was 2.370 (1.720, 3.265, P < 0.001). The aHR (95% CI) for T2N0M0 compared with T1N0M0 was 1.752 (1.321-2.32, P < 0.001). The aHR (95% CI) for Charlson Comorbidity Index (CCI) ≥ 2 compared with CCI = 0 was 1.264 (1.137-1.738, P = 0.011). After stratified analysis, the aHRs for surgery compared with definitive RT were 0.484 (0.352-0.665, P < 0.001) and 0.411 (0.232-0.728, P = 0.002) among old and very old patients with E-OCSCC, respectively. CONCLUSIONS: Surgery may be more beneficial than definitive RT in selected elderly patients with E-OCSCC.
PURPOSE: Although patients aged >70 years are subject to early oral cavity squamous cell carcinoma (E-OCSCC), evidence is currently lacking regarding the probable outcomes of definitive radiotherapy (RT) compared to surgery in this population. METHODS: We recruited patients aged ≥70 years with a diagnosis of E-OCSCC from the Taiwan Cancer Registry Database. Propensity score matching was performed, and Cox proportional-hazards model curves were used to analyze all-cause mortality of patients at different age intervals undergoing different treatments. RESULTS: The matching process yielded a final cohort of 604 patients in the definitive RT and surgery cohorts who were eligible for further analysis. These patients were classified as old (70-80 years) and very old (>80 years). In the multivariate Cox regression analysis, the adjusted hazard ratio (aHR) (95% confidence interval [CI]) for surgery compared with definitive RT was 0.465 (0.354-0.610, P < 0.001). The aHR (95% CI) for age >80 years compared with age 70-80 years was 2.370 (1.720, 3.265, P < 0.001). The aHR (95% CI) for T2N0M0 compared with T1N0M0 was 1.752 (1.321-2.32, P < 0.001). The aHR (95% CI) for Charlson Comorbidity Index (CCI) ≥ 2 compared with CCI = 0 was 1.264 (1.137-1.738, P = 0.011). After stratified analysis, the aHRs for surgery compared with definitive RT were 0.484 (0.352-0.665, P < 0.001) and 0.411 (0.232-0.728, P = 0.002) among old and very old patients with E-OCSCC, respectively. CONCLUSIONS: Surgery may be more beneficial than definitive RT in selected elderly patients with E-OCSCC.