Clinicopathological parameters and outcome of 245 patients operated for oral squamous cell carcinoma
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 (, 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
References (38)
Modified neck dissection: a study of 967 cases from 1970 to 1980
Am J Surg
(1985)- et al.
A comparison between TNM and TANIS stage grouping for predicting prognosis of oral and oropharyngeal cancer
Oral Maxillofac Surg
(1998) - et al.
Changing the staging of oral cancer
J Oral Maxillofac Surg
(1999) - et al.
Prognostic value of the number of involved nodes after neck dissection in oropharyngeal and oral cavity carcinoma
Cancer Radiother
(2001) - et al.
Long-term results in treating squamous cell carcinoma of the lip, oral cavity, and oropharynx
Int J Oral Maxillofac Surg
(1989) - et al.
Supraomohyoid neck dissection in the treatment of T1/T2 squamous cell carcinoma of oral cavity
Am J Surg
(1994) - et al.
Supraomohyoid neck dissection in cancer of the oral cavity
Am J Surg
(1999) - et al.
Marginal and segmental mandibulectomy in patients with oral cancer: a statistical analysis of 106 cases
J Oral Maxillofac Surg
(2003) - et al.
Survival evaluation of treatment modality in squamous cell carcinoma of the oral cavity and oropharynx
J Craniomaxillofac Surg
(2000) - et al.
The status of the resection margin as a prognostic factor in the treatment of head and neck carcinoma
J Cranio-maxillofac Surg
(1991)