Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
권호 표지
DOI QR코드

DOI QR Code

Analysis of prognostic factors through survival rate analysis of oral squamous cell carcinoma patients treated at the National Cancer Center: 20 years of experience

  • Choi, Yong-Seok (Oral Oncology Clinic, Research Institute and Hospital, National Cancer Center) ;
  • Kim, Min Gyeong (Oral Oncology Clinic, Research Institute and Hospital, National Cancer Center) ;
  • Lee, Jong-Ho (Oral Oncology Clinic, Research Institute and Hospital, National Cancer Center) ;
  • Park, Joo-Yong (Oral Oncology Clinic, Research Institute and Hospital, National Cancer Center) ;
  • Choi, Sung-Weon (Oral Oncology Clinic, Research Institute and Hospital, National Cancer Center)
  • Received : 2022.09.27
  • Accepted : 2022.10.01
  • Published : 2022.10.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives: This study aimed to analyze the clinicopathological prognostic factors affecting the survival of patients with oral squamous cell carcinoma (OSCC). Materials and Methods: A retrospective study was conducted on patients with OSCC who received treatment at the Oral Oncology Clinic of the National Cancer Center (NCC) from June 2001 to December 2020. The patients' sex, age, primary site, T stage, node metastasis, TNM staging, perineural invasion (PNI), lymphovascular invasion (LVI), differentiation, surgical resection margin, smoking, and drinking habits were investigated to analyze risk factors. For the univariate analysis, a Kaplan-Meier survival analysis and log-rank test were used. Additionally, for the multivariable analysis, a Cox proportional hazard model analysis was used. For both analyses, statistical significance was considered when P<0.05. Results: During the investigation period, 407 patients were received surgical treatment at the NCC. Their overall survival rate (OS) for five years was 70.7%, and the disease-free survival rate (DFS) was 60.6%. The multivariable analysis revealed that node metastasis, PNI, and differentiation were significantly associated with poor OS. For DFS, PNI and differentiation were associated with poor survival rates. Conclusion: In patients with OSCC, cervical node metastasis, PNI, and differentiation should be considered important prognostic factors for postoperative survival.

Keywords

References

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71:209-49. https://doi.org/10.3322/caac.21660
  2. Rivera C. Essentials of oral cancer. Int J Clin Exp Pathol 2015;8:11884-94. https://doi.org/10.5281/zenodo.192487
  3. Kang MJ, Won YJ, Lee JJ, Jung KW, Kim HJ, Kong HJ, et al.; Community of Population-Based Regional Cancer Registries. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2019. Cancer Res Treat 2022;54:330-44. https://doi.org/10.4143/crt.2022.128
  4. Sklenicka S, Gardiner S, Dierks EJ, Potter BE, Bell RB. Survival analysis and risk factors for recurrence in oral squamous cell carcinoma: does surgical salvage affect outcome? J Oral Maxillofac Surg 2010;68:1270-5. https://doi.org/10.1016/j.joms.2009.11.016
  5. Amit M, Yen TC, Liao CT, Chaturvedi P, Agarwal JP, Kowalski LP, et al.; International Consortium for Outcome Research (ICOR) in Head and Neck Cancer. Improvement in survival of patients with oral cavity squamous cell carcinoma: an international collaborative study. Cancer 2013;119:4242-8. https://doi.org/10.1002/cncr.28357
  6. Almangush A, Makitie AA, Triantafyllou A, de Bree R, Strojan P, Rinaldo A, et al. Staging and grading of oral squamous cell carcinoma: an update. Oral Oncol 2020;107:104799. https://doi.org/10.1016/j.oraloncology.2020.104799
  7. Patel SG, Lydiatt WM. Staging of head and neck cancers: is it time to change the balance between the ideal and the practical? J Surg Oncol 2008;97:653-7. https://doi.org/10.1002/jso.21021
  8. Funk GF, Karnell LH, Robinson RA, Zhen WK, Trask DK, Hoffman HT. Presentation, treatment, and outcome of oral cavity cancer: a National Cancer Data Base report. Head Neck 2002;24:165-80. https://doi.org/10.1002/hed.10004
  9. Leite IC, Koifman S. Survival analysis in a sample of oral cancer patients at a reference hospital in Rio de Janeiro, Brazil. Oral Oncol 1998;34:347-52. https://doi.org/10.1016/s1368-8375(98)00019-0
  10. Oh MS, Kang SH, Kim HJ, Zhenglin Z, Ryu JI, Nam W, et al. Overall five-year survival rate in squamous cell carcinoma of oral cavity. J Korean Assoc Oral Maxillofac Surg 2009;35:83-8.
  11. Sim YC, Hwang JH, Ahn KM. Overall and disease-specific survival outcomes following primary surgery for oral squamous cell carcinoma: analysis of consecutive 67 patients. J Korean Assoc Oral Maxillofac Surg 2019;45:83-90. https://doi.org/10.5125/jkaoms.2019.45.2.83
  12. Arduino PG, Carrozzo M, Chiecchio A, Broccoletti R, Tirone F, Borra E, et al. Clinical and histopathologic independent prognostic factors in oral squamous cell carcinoma: a retrospective study of 334 cases. J Oral Maxillofac Surg 2008;66:1570-9. https://doi.org/10.1016/j.joms.2007.12.024
  13. Mosleh-Shirazi MS, Mohammadianpanah M, Mosleh-Shirazi MA. Squamous cell carcinoma of the oral tongue: a 25-year, single institution experience. J Laryngol Otol 2009;123:114-20. https://doi.org/10.1017/S0022215108003186
  14. Fang QG, Shi S, Liu FY, Sun CF. Tongue squamous cell carcinoma as a possible distinct entity in patients under 40 years old. Oncol Lett 2014;7:2099-102. https://doi.org/10.3892/ol.2014.2054
  15. Soudry E, Preis M, Hod R, Hamzany Y, Hadar T, Bahar G, et al. Squamous cell carcinoma of the oral tongue in patients younger than 30 years: clinicopathologic features and outcome. Clin Otolaryngol 2010;35:307-12. https://doi.org/10.1111/j.1749-4486.2010.02164.x
  16. Park JO, Sun DI, Cho KJ, Joo YH, Yoo HJ, Kim MS. Clinical outcome of squamous cell carcinoma of the tongue in young patients: a stage-matched comparative analysis. Clin Exp Otorhinolaryngol 2010;3:161-5. https://doi.org/10.3342/ceo.2010.3.3.161
  17. Pytynia KB, Grant JR, Etzel CJ, Roberts D, Wei Q, Sturgis EM. Matched analysis of survival in patients with squamous cell carcinoma of the head and neck diagnosed before and after 40 years of age. Arch Otolaryngol Head Neck Surg 2004;130:869-73. https://doi.org/10.1001/archotol.130.7.869
  18. Ho HC, Lee MS, Hsiao SH, Hwang JH, Hung SK, Chou P, et al. Squamous cell carcinoma of the oral cavity in young patients: a matched-pair analysis. Eur Arch Otorhinolaryngol 2008;265 Suppl 1:S57-61. https://doi.org/10.1007/s00405-007-0496-5
  19. Udeabor SE, Rana M, Wegener G, Gellrich NC, Eckardt AM. Squamous cell carcinoma of the oral cavity and the oropharynx in patients less than 40 years of age: a 20-year analysis. Head Neck Oncol 2012;4:28. https://doi.org/10.1186/1758-3284-4-28
  20. Cruchley AT, Bergmeier LA. Structure and functions of the oral mucosa. In: Bergmeier LA, ed. Oral mucosa in health and disease: a concise handbook. Cham: Springer; 2018:1-18.
  21. Choi KK, Kim MJ, Yun PY, Lee JH, Moon HS, Lee TR, et al. Independent prognostic factors of 861 cases of oral squamous cell carcinoma in Korean adults. Oral Oncol 2006;42:208-17. https://doi.org/10.1016/j.oraloncology.2005.07.005
  22. Tadbir AA, Ashraf MJ, Sardari Y. Prognostic significance of stromal eosinophilic infiltration in oral squamous cell carcinoma. J Craniofac Surg 2009;20:287-9. https://doi.org/10.1097/SCS.0b013e318199219b
  23. Woolgar JA. Histopathological prognosticators in oral and oropharyngeal squamous cell carcinoma. Oral Oncol 2006;42:229-39. https://doi.org/10.1016/j.oraloncology.2005.05.008
  24. Rahima B, Shingaki S, Nagata M, Saito C. Prognostic significance of perineural invasion in oral and oropharyngeal carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97:423-31. https://doi.org/10.1016/j.tripleo.2003.10.014
  25. Soo KC, Carter RL, O'Brien CJ, Barr L, Bliss JM, Shaw HJ. Prognostic implications of perineural spread in squamous carcinomas of the head and neck. Laryngoscope 1986;96:1145-8. https://doi.org/10.1288/00005537-198610000-00015
  26. Liao CT, Chang JT, Wang HM, Ng SH, Hsueh C, Lee LY, et al. Does adjuvant radiation therapy improve outcomes in pT1-3N0 oral cavity cancer with tumor-free margins and perineural invasion? Int J Radiat Oncol Biol Phys 2008;71:371-6. https://doi.org/10.1016/j.ijrobp.2007.10.015
  27. Chen TC, Wang CP, Ko JY, Yang TL, Hsu CW, Yeh KA, et al. The impact of perineural invasion and/or lymphovascular invasion on the survival of early-stage oral squamous cell carcinoma patients. Ann Surg Oncol 2013;20:2388-95. https://doi.org/10.1245/s10434-013-2870-4
  28. Mascitti M, Togni L, Caponio VCA, Zhurakivska K, Bizzoca ME, Contaldo M, et al. Lymphovascular invasion as a prognostic tool for oral squamous cell carcinoma: a comprehensive review. Int J Oral Maxillofac Surg 2022;51:1-9. https://doi.org/10.1016/j.ijom.2021.03.007
  29. Ding D, Stokes W, Eguchi M, Hararah M, Sumner W, Amini A, et al. Association between lymph node ratio and recurrence and survival outcomes in patients with oral cavity cancer. JAMA Otolaryngol Head Neck Surg 2019;145:53-61. https://doi.org/10.1001/jamaoto.2018.2974
  30. Chang WC, Chang CF, Li YH, Yang CY, Su RY, Lin CK, et al. A histopathological evaluation and potential prognostic implications of oral squamous cell carcinoma with adverse features. Oral Oncol 2019;95:65-73. https://doi.org/10.1016/j.oraloncology.2019.06.012
  31. Adel M, Kao HK, Hsu CL, Huang JJ, Lee LY, Huang Y, et al. Evaluation of lymphatic and vascular invasion in relation to clinicopathological factors and treatment outcome in oral cavity squamous cell carcinoma. Medicine (Baltimore) 2015;94:e1510. https://doi.org/10.1097/MD.0000000000001510
  32. Kim HC, Kusukawa J, Kameyama T. Clinicopathologic parameters in predicting cervical nodal metastasis in early squamous cell carcinoma of the oral cavity. Kurume Med J 1993;40:183-92. https://doi.org/10.2739/kurumemedj.40.183
  33. Kademani D, Bell RB, Bagheri S, Holmgren E, Dierks E, Potter B, et al. Prognostic factors in intraoral squamous cell carcinoma: the influence of histologic grade. J Oral Maxillofac Surg 2005;63:1599-605. https://doi.org/10.1016/j.joms.2005.07.011
  34. Lin NC, Hsu JT, Tsai KY. Survival and clinicopathological characteristics of different histological grades of oral cavity squamous cell carcinoma: a single-center retrospective study. PLoS One 2020;15:e0238103. https://doi.org/10.1371/journal.pone.0238103
  35. Wang B, Zhang S, Yue K, Wang XD. The recurrence and survival of oral squamous cell carcinoma: a report of 275 cases. Chin J Cancer 2013;32:614-8. https://doi.org/10.5732/cjc.012.10219
  36. Kim KY, Zhang X, Kim SM, Lee BD, Cha IH. A combined prognostic factor for improved risk stratification of patients with oral cancer. Oral Dis 2017;23:91-6. https://doi.org/10.1111/odi.12579
  37. Sawair FA, Irwin CR, Gordon DJ, Leonard AG, Stephenson M, Napier SS. Invasive front grading: reliability and usefulness in the management of oral squamous cell carcinoma. J Oral Pathol Med 2003;32:1-9. https://doi.org/10.1034/j.1600-0714.2003.00060.x
  38. Alicandri-Ciufelli M, Bonali M, Piccinini A, Marra L, Ghidini A, Cunsolo EM, et al. Surgical margins in head and neck squamous cell carcinoma: what is 'close'? Eur Arch Otorhinolaryngol 2013;270:2603-9. https://doi.org/10.1007/s00405-012-2317-8
  39. Bernier J, Cooper JS, Pajak TF, van Glabbeke M, Bourhis J, Forastiere A, et al. Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 2005;27:843-50. https://doi.org/10.1002/hed.20279
  40. Zanoni DK, Migliacci JC, Xu B, Katabi N, Montero PH, Ganly I, et al. A proposal to redefine close surgical margins in squamous cell carcinoma of the oral tongue. JAMA Otolaryngol Head Neck Surg 2017;143:555-60. https://doi.org/10.1001/jamaoto.2016.4238
  41. Wong LS, McMahon J, Devine J, McLellan D, Thompson E, Farrow A, et al. Influence of close resection margins on local recurrence and disease-specific survival in oral and oropharyngeal carcinoma. Br J Oral Maxillofac Surg 2012;50:102-8. https://doi.org/10.1016/j.bjoms.2011.05.008
  42. Chamoli A, Gosavi AS, Shirwadkar UP, Wangdale KV, Behera SK, Kurrey NK, et al. Overview of oral cavity squamous cell carcinoma: risk factors, mechanisms, and diagnostics. Oral Oncol 2021;121:105451. https://doi.org/10.1016/j.oraloncology.2021.105451
  43. Boffetta P, Garfinkel L. Alcohol drinking and mortality among men enrolled in an American Cancer Society prospective study. Epidemiology 1990;1:342-8. https://doi.org/10.1097/00001648-199009000-00003
  44. Bundgaard T, Bentzen SM, Wildt J. The prognostic effect of tobacco and alcohol consumption in intra-oral squamous cell carcinoma. Eur J Cancer B Oral Oncol 1994;30B:323-8. https://doi.org/10.1016/0964-1955(94)90033-7
  45. Capote-Moreno A, Brabyn P, Munoz-Guerra MF, Sastre-Perez J, Escorial-Hernandez V, Rodriguez-Campo FJ, et al. Oral squamous cell carcinoma: epidemiological study and risk factor assessment based on a 39-year series. Int J Oral Maxillofac Surg 2020;49:1525-34. https://doi.org/10.1016/j.ijom.2020.03.009