Clinical Outcomes of Taiwanese Patients with cT4 Oral Cavity Squamous Cell Carcinoma: Toward the Identification of the Optimal Initial Treatment Approach for cT4b Patients

Chun Ta Liao, Yu Wen Wen, Shu Ru Lee, Tsang Wu Liu, Sen Tien Tsai, Ming Hsui Tsai, Jin Ching Lin, Pei Jen Lou, Pen Yuan Chu, Yi Shing Leu, Kuo Yang Tsai, Shyuang Der Terng, Tsung Ming Chen, Cheng Hsu Wang, Chih Yen Chien, Wen Cheng Chen, Li Yu Lee, Chien Yu Lin, Hung Ming Wang, Shu Hang NgChih Hung Lin, Tuan Jen Fang, Shiang Fu Huang, Chung Jan Kang, Kai Ping Chang, Lan Yan Yang, Tzu Chen Yen, the Taiwan Oral Cancer Advisory Group for the Taiwan Oral Cancer Advisory Group

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6 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)785-793
Number of pages9
JournalAnnals of Surgical Oncology
Volume24
Issue number3
DOIs
Publication statusPublished - 2017 Mar 1

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology

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    Liao, C. T., Wen, Y. W., Lee, S. R., Liu, T. W., Tsai, S. T., Tsai, M. H., Lin, J. C., Lou, P. J., Chu, P. Y., Leu, Y. S., Tsai, K. Y., Terng, S. D., Chen, T. M., Wang, C. H., Chien, C. Y., Chen, W. C., Lee, L. Y., Lin, C. Y., Wang, H. M., ... for the Taiwan Oral Cancer Advisory Group, T. T. O. C. A. G. (2017). Clinical Outcomes of Taiwanese Patients with cT4 Oral Cavity Squamous Cell Carcinoma: Toward the Identification of the Optimal Initial Treatment Approach for cT4b Patients. Annals of Surgical Oncology, 24(3), 785-793. https://doi.org/10.1245/s10434-016-5629-x