Clinicopathological Analyses and Predictive Factors for Loco-Regional Recurrences in Patients With Oral Squamous Cell Carcinoma
A total of 202 patients with previously untreated OSCC underwent radical resection between 2002 and 2012 was included in this study. The most common primary site was the oral tongue (81), followed by the lower gingiva (47), buccal mucosa (28), upper gingiva (19), floor of the mouth (18), and the others (9). There were 61 patients with T1 tumors, 90 with T2 tumors, 12 with T3 tumors, and 39 with T4 tumors. The number of patients with N0, N1, N2, and N3 were 153, 22, 26 and 1 respectively. A total of 112 neck dissections were performed in 101 patients. Sixty- four were simultaneously with resection of primary lesion and 37 were secondary because of developed neck metastasis during the follow- up period. The relationship of T, N, stage, grade(WHO), surgical margin, adjuvant chemotherapy, extracapsular spread (ECS), numbers and levels of metastatic nodes and loco-regional recurrence were evaluated. The disease-specific survival rate (DSSR) was calculated using the Kaplan- Meier method, and the significance of the factors influencing outcome was determined by the log- rank test. Multivariate analyses to assess the influence of different variables in the outcome were evaluated by Cox regression.
The 5-year DSSR for all patients was 88%. Twenty- two of the 202 patients (11%) developed local recurrence after the completion of the initial treatment. There were 3 in tongue, 7 in lower gingiva, 5 in buccal mucosa and upper gingiva, 1 in floor of the mouth and the others. The median time of development of local recurrence after the initial treatment was 221 days (range, 24-904 days), and almost all of these (18 patients, 82%) were within one year. The 5-year DSSRs for patients with or without local recurrence were 50% and 92%, respectively (P=0.01). Ten of 14 patients were salvaged by secondary surgical treatment. Cox regression analyses revealed that the positive surgical margins and the presence of nodal metastasis were independent risk factors for local recurrence (HR: 5.866, 3.127, respectively). The number of neck recurrence was 11 of 101 patients (11%). In all of the neckrecurrences occurred within one year (median, 148 days and range, 20-261 days). The 5-year DSSRs for patients with or without neck recurrence were 38% and 78%, respectively (P<0.01). Of the 11 patients with neck recurrence, surgical treatment was carried out for 5 patients and a1l of these were salvaged successfully. The remaining six patients were treated with various modalities were not controlling the disease successfully. On multivariate analyses, bilateral neck metastasis (HR: 2.561) and ECS (HR: 2.507) were indepensent factorsfor neck recurrence.
In the present study, 30 of the 202 patients treated definitely for OSCC recurred local and/or neck. The significant factors associated with loco-regional recurrence were the status of surgical margins and neck node metastasis. The close follow- up and early detection of the recurrence are essential to manage the recurrence of loco-regional disease.
Reference
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2) Andersen PE, et al.: The role of comprehensive neck dissection with preservation of the spinal accessory nerve in the clinically positive neck. Am J Surge 168: 499-502, 1994