Factors affecting prognosis in locoregional recurrence of oral squamous cell carcinoma

Abstract

Background Recurrence of oral squamous cell carcinoma (rOSCC) after primary treatment is associated with poor survival outcomes. Salvage treatment with further surgery, radiotherapy and chemotherapy has high morbidity, making patient selection crucial. However, in the recurrence setting, reliable stratification data are scarce. Decision‐making in this context is consequently complex. We investigated factors influencing overall survival after rOSCC. Methods Retrospective cohort study of patients with rOSCC (n = 83) at the Queen Elizabeth Hospital Birmingham, UK between 2006 and 2016. Associations with overall survival were analysed using univariate and multivariate analyses to identify important clinical prognostic indicators. Results Overall survival at 1 year was 32.5% and at 5 years was 18.1% after a median follow‐up of 7.4 months. Multivariate analysis identified four independent predictors of overall survival following rOSCC: size of primary tumour (HR 2.077; 95% CI 1.034‐4.172), extent of recurrent disease (HR 3.286; 95% CI 1.545‐6.991), history of moderate alcohol consumption (HR 0.351; 95% CI 0.162‐0.763), and close or positive margins at primary resection (HR 1.955; 95% CI 1.063‐3.595). Conclusions We identified four key factors that help prognostication and risk stratification of rOSCC. Given the high morbidity associated with salvage treatment, we recommend that the multidisciplinary team (MDT) and the patient weigh these factors carefully when considering further treatment. Further investigation of the biology underlying these oncophenotypes may contribute to better patient stratification.

Prognostic Factors Associated with Successful Salvage Surgery in Recurrent Oral Cancer

“…Similarly, Matsuura et al found shorter survival times (OS and DFS) in patients with nodal involvement in the primary resection [ 20 ]. Consistent with previous reports [ 13 , 19 , 21 ], we found that positive resection margins had a negative impact on OS in patients with recurrent disease.…”

“…We found that several factors—N+ neck, PNI, LVI, ENE, and positive surgical margins—were associated with disease recurrence, a finding that is consistent with previous reports [ 11 , 12 , 13 , 14 , 15 ]. In our sample, 108 patients developed disease recurrence a mean of 20.8 months after primary treatment.…”

“…Unlike in our study, other independent factors were history of alcohol consumption (not examined in our study) and extent of recurrent disease (non-significant in our study). Those authors also emphasized the technical challenges of salvage surgery and the high treatment-related morbidity rates, which include speech and swallowing difficulties [ 13 ].…”

Do betel quid and areca nut chewing deteriorate prognosis of oral cancer? A systematic review, meta‐analysis, and research agenda

“…There seem to be no gender differences in this association. Besides serving as the risk factors of OC, smoking and drinking have also been identified as adverse prognostic factors of OC (Borsetto et al., 2019; Feghali et al., 2019). Areca nut (AN), the main component of betel quid (BQ), has been classified as a human carcinogen by the International Agency for Research on Cancer (Dave, Trivedi, & Adhvaryu, 1992) and identified as an independent risk factor for OC (Chen et al., 2008).…”

MicroRNA-1179 suppresses the proliferation and enhances vincristine sensitivity of oral cancer cells via induction of apoptosis and modulation of MEK/ERK and PI3K/AKT signalling pathways

“…The overall 5-year survival rate of oral cancer is only 62% as against 89% and 99% for breast and oral cancers, respectively (Gupta et al 2016 ). Additionally, the recurrence of human oral cancer further adds to the problem (Borsetto et al 2019 ). Hence, it is need of the hour to look for the alternative approaches for the management of oral cancer.…”