Clinicopathological parameters and outcome of 245 patients operated for oral squamous cell carcinoma

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Summary

Introduction

This report analysed the outcome of patients undergoing surgery for oral squamous cell carcinoma in order to identify the prognostic value of several factors.

Patients

A total of 245 patients were studied who had undergone surgery for oral squamous cell carcinoma between 1989 and 2002, of whom 109 had received postoperative radiation therapy.

Methods

For each patient, personal data, alcohol and tobacco consumption, symptoms, histological findings, treatment, and outcome were recorded and analysed statistically. Survival curves were calculated using the Kaplan–Meier algorithm, and the difference in survival among subgroups was examined.

Results

The overall 5-year survival rate in the 245 patients was 63% (72.5% at 3 years). The differences in the 5-year survival were significant (p<0.05) for the site of origin, N and pN status, TNM stage, grading, status of the resection margins, osseous infiltration, and perineural invasion. Vascular involvement as a discriminator was not statistically significant. In patients undergoing radiation therapy, only perineural invasion negatively influenced the 5-year survival prognosis (p<0.01).

Conclusion

The overall survival rate was within the (previously) reported range. The prognostic value of many parameters is widely recognized; the combined evaluation of ‘composite factors’ is promising.

Introduction

Despite changes in the treatment of oral squamous cell carcinoma over the last few decades, the prognosis remains uncertain. Curability depends on the stage and specific site of the tumour (Carinci et al., 1997). The status of the cervical nodes is the single most important prognostic indicator for survival of patients with oral cancer (Denis et al., 2001; Tankere et al., 2000; Woolgar, 1997). Over the last 20 years, there has been a slight decrease in mortality rates, but the reported results are heterogeneous and the overall 5-year survival rate varies from 41% to 79.5%. Surgery remains the mainstay of treatment; other therapies include radiation and chemotherapy, which may be used as an adjunct or for palliation (Charabi et al., 1997).

This report assessed the outcome in a series of 245 patients with the diagnosis of oral squamous cell carcinoma. The results were analysed to identify prognostic factors (Beenken et al., 1999; Davis, 1985; Hibbert et al., 1983; Martinez-Gimeno et al., 1995).

Section snippets

Patients

Between 1989 and 2002, 245 patients with a diagnosis of oral cancer underwent treatment in the Division of Maxillofacial Surgery of the University of Turin and form the basis of this study. The patient population comprised 151 men (62%) and 94 women (38%), a gender ratio of 1.6:1. Their mean age was 62.0±11.7 years (range 24–89 years), with a significant statistical difference (p=0.002, confidence interval (CI) 95%: 1.9–7.8) between males (60.2±11.8) and females (65.0±11.0 years). All patients

Methods

All 245 patients that had undergone surgical treatment with the key elements of treatment protocol being: initial radical surgery for the primary tumour; preservation of the mandibular continuity whenever possible by means of marginal resection of the jaw and the mandibular swing procedure (Munoz Guerra et al., 2003); radical neck dissection in cases with major tumour invasion; primary reconstruction, traditional or microsurgical, considering the type of defect and performance status of the

Results

During the period considered, 79 (32%) patients died and 166 (68%) were still alive. For the patients who died, the maximum survival time was 4.99 years. The overall cumulative survival rate 3 years postoperatively was 72.5% (147 patients), while at 5 years it was 63%. There was ‘no recurrence’ in 148 patients (60%), while 97 (40%) developed a ‘recurrence’ during the period of observation, consisting of a ‘local recurrence’ in 32 and a ‘neck recurrence’ in 65. Of the latter 65 patients with a

Discussion

The overall survival for the patients with oral squamous cell carcinoma reported here was within the range reported in the recent literature (Hemprich and Muller, 1989; Pericot et al., 2000; Sheahan et al., 2003; Zhao et al., 1989).

The site of origin of oral cancer is an important prognostic factor (Carinci et al., 1997; Woolgar and Scott, 1995). In this series, the cumulative survival at 3 and 5 years after diagnosis was slightly lower for lower and posterior sites in the oral cavity. Stage,

Conclusion

The site of origin of squamous cell carcinoma seems to be one of the most predictive factors in patient prognosis. This is why strategies and treatment modalities differed between oral and oropharyngeal cancer. Future studies should analyse the influence of prognostic factors and the results of therapy selectively for each subsite of the oral cavity. However, it is possible that, in the future, no single prognostic factor will be the key, but treatment should be based on a comprehensive

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