Chun-Ta Liao1, Yu-Wen Wen2, Shu-Ru Lee3, Lan-Yan Yang4, Chih-Hung Lin5, Shu-Hang Ng6, Tsang-Wu Liu7, Sen-Tien Tsai8, Ming-Hsui Tsai9, Jin-Ching Lin10, Chih-Yen Chien11, Pei-Jen Lou12, Cheng-Ping Wang12, Pen-Yuan Chu13, Yi-Shing Leu14, Kuo-Yang Tsai15, Shyuang-Der Terng16, Tsung-Ming Chen17, Cheng-Hsu Wang18, Wen-Cheng Chen19, Li-Yu Lee20, Chien-Yu Lin21, Hung-Ming Wang22, Tuan-Jen Fang1, Shiang-Fu Huang1, Chung-Jan Kang1, Kai-Ping Chang1, Tzu-Chen Yen23. 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. Research Service Center for Health Information, Chang Gung University, Taoyuan, Taiwan. 4. Biostatistics and Informatics Unit, Clinical Trial Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. lyyang0111@gmail.com. 5. Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. profchlin@gmail.com. 6. Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. 7. National Institute of Cancer Research, National Health Research Institutes, Miaoli, Taiwan. 8. Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. 9. Department of Otorhinolaryngology, Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan. 10. Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan. 11. Department of Otolaryngology, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan. 12. Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan. 13. Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan. 14. Department of Otolaryngology, Mackay Memorial Hospital, Taipei, Taiwan. 15. Department of Oral and Maxillofacial Surgery, Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan. 16. Department of Head and Neck Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan. 17. Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. 18. Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan. 19. Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan. 20. Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. 21. Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. 22. Department of Medical Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. 23. Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
Abstract
BACKGROUND: We sought to compare the clinical outcomes of Taiwanese patients with resected oral cavity squamous cell carcinoma (OCSCC) who underwent reconstruction with free versus local flaps. METHODS: From 2011 to 2017, we examined 8646 patients with first primary OCSCC who received surgery either with or without adjuvant therapy. Of these patients, 7297 and 1349 received free and local flap reconstruction, respectively. Two propensity score-matched groups of patients who underwent free versus local flap (n = 1268 each) reconstructions were examined. Margin status was not included as a propensity score-matched variable. RESULTS: Compared with local flaps, patients who received free flaps had a higher prevalence of the following variables: male sex, age < 65 years, pT3-4, pN1-3, p-Stage III-IV, depth ≥ 10 mm, margin > 4 mm, extranodal extension (ENE), and adjuvant therapy (all p < 0.0001). Multivariable analysis identified the reconstruction method (local vs. free flaps, only overall survival [OS]), age ≥ 65 years, pT3-4, pN1-3, p-Stage III-IV, depth ≥ 10 mm (only OS), margins ≤ 4 mm, and ENE as independent adverse prognosticators for disease-specific survival (DSS) and OS. The results of propensity score-matched analyses revealed that, compared with free flaps, patients who underwent local flap reconstruction showed less favorable 5-year DSS (hazard ratio [HR] 1.26, 82%/77%; p = 0.0100) and OS (HR 1.21, 73%/68%; p = 0.0079). CONCLUSIONS: After adjusting for covariates using multivariate models, and also by propensity score modeling, OCSCC patients who underwent free flap reconstruction showed a higher frequency of clear margins and a significant survival advantage compared with those who received local flaps.
BACKGROUND: We sought to compare the clinical outcomes of Taiwanese patients with resected oral cavity squamous cell carcinoma (OCSCC) who underwent reconstruction with free versus local flaps. METHODS: From 2011 to 2017, we examined 8646 patients with first primary OCSCC who received surgery either with or without adjuvant therapy. Of these patients, 7297 and 1349 received free and local flap reconstruction, respectively. Two propensity score-matched groups of patients who underwent free versus local flap (n = 1268 each) reconstructions were examined. Margin status was not included as a propensity score-matched variable. RESULTS: Compared with local flaps, patients who received free flaps had a higher prevalence of the following variables: male sex, age < 65 years, pT3-4, pN1-3, p-Stage III-IV, depth ≥ 10 mm, margin > 4 mm, extranodal extension (ENE), and adjuvant therapy (all p < 0.0001). Multivariable analysis identified the reconstruction method (local vs. free flaps, only overall survival [OS]), age ≥ 65 years, pT3-4, pN1-3, p-Stage III-IV, depth ≥ 10 mm (only OS), margins ≤ 4 mm, and ENE as independent adverse prognosticators for disease-specific survival (DSS) and OS. The results of propensity score-matched analyses revealed that, compared with free flaps, patients who underwent local flap reconstruction showed less favorable 5-year DSS (hazard ratio [HR] 1.26, 82%/77%; p = 0.0100) and OS (HR 1.21, 73%/68%; p = 0.0079). CONCLUSIONS: After adjusting for covariates using multivariate models, and also by propensity score modeling, OCSCC patients who underwent free flap reconstruction showed a higher frequency of clear margins and a significant survival advantage compared with those who received local flaps.
Authors: T T Tsue; S S Desyatnikova; F W Deleyiannis; N D Futran; B C Stack; E A Weymuller; M G Glenn Journal: Arch Otolaryngol Head Neck Surg Date: 1997-07
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