Prognostic factors, failure patterns and survival analysis in patients with resectable oral squamous cell carcinoma of the tongue

Abstract

Purpose There is sparse literature on treatment outcomes research on resectable oral tongue squamous cell carcinoma (OTSCC). The aim of this study was to measure the treatment outcomes, explore the failure patterns, and identify the potential clinicopathological prognostic factors affecting treatment outcomes for resectable OTSCC. Materials and Methods It is a retrospective analysis of 202 patients with resectable OTSCC who underwent upfront primary surgical resection followed by adjuvant radiotherapy with or without concurrent chemotherapy if indicated. Results The median follow-up was 35.2 months (range, 1.2 to 99.9 months). The median duration of locoregional control (LRC) was 84.9 months (95% confidence interval, 67.3–102.4). The 3- and 5-year LRC rate was 68.5% and 58.3%, respectively. Multivariate analysis showed that increasing pT stage, increasing pN stage, and the presence of extracapsular extension (ECE) were significantly associated with poorer LRC. The median duration of overall survival (OS) was not reached at the time of analysis. The 3- and 5-year OS rate was 70.5% and 66.6%, respectively. Multivariate analysis showed that increasing pT stage and the presence of ECE were significantly associated with a poorer OS. Conclusion Locoregional failure remains the main cause of treatment failure in resectable OTSCC. There is scope to further improve prognosis considering modest LRC and OS. Pathological T-stage, N-stage, and ECE are strong prognostic factors. Further research is required to confirm whether adjuvant therapy adds to treatment outcomes in cases with lymphovascular invasion, perineural invasion, and depth of invasion, and help clinicians tailoring adjuvant therapy.

Impact of lymphovascular invasion in oral squamous cell carcinoma: A meta-analysis

“…There were 26 studies originated from Asian countries (China, India, Korea, Japan, and Pakistan), and the remaining ten studies were from non-Asian countries (USA, Europe, Australia, Italy and Brazil). Among them, ten studies included oral tongue SCC [14][15][16][17][18][19][20][21][22][23][24] , and the other two studies were focused on floor of mouth cancer 7 and buccal mucosa SCC 25 , respectively. The tumor site of OSCC was mixed in the other 24 studies .…”

“…OS, DSS, DFS were the identified endpoints. Among them, 11 studies including 12783 patients reported the OS 7,17,20,22,26,30,31,37,38,41,46 (Figure 3A), seven studies involving 3470 patients reported the DSS 24, 32, 37-39, 46, 47 (Figure 3B), and the other three researches with 731 follow-ups reported the DFS 25,30,43 ( Figure 3C). Among studies focused on OS, Wei study (2019) 46 from Group DSS was excluded on account of overlapping with the patient pool of Chen study (2014) 31 .…”

Deregulation of extracellular matrix modeling with molecular prognostic markers revealed by transcriptome sequencing and validations in Oral Tongue squamous cell carcinoma

“…However, the inaccuracy of clinical examination and imaging to reliably detect occult cervical lymph node micrometastasis has resulted in elective neck dissections becoming a standard of care for a vast majority of the OTSCC management, based on the evidences from randomised controlled trials 9 . The other clinicopathological factors predicting poor prognosis include increased depth of invasion 10 , 11 , increasing pT, the presence of extra-capsular extension 12 , 13 and endophytic appearance of tumor 14 . In spite of the multiple attempts made to classify molecular markers in OTSCC with promising candidates emerging 15 – 19 , they have not been translated to clinics and therapeutic decisions are still largely driven by the classical clinico-pathological factors like tumor stage, patient’s age and performance status 20 which may be insufficient.…”

“…other clinicopathological factors predicting poor prognosis include increased depth of invasion 10,11 , increasing pT, the presence of extra-capsular extension 12,13 and endophytic appearance of tumor 14 . In spite of the multiple attempts made to classify molecular markers in OTSCC with promising candidates emerging [15][16][17][18][19] , they have not been translated to clinics and therapeutic decisions are still largely driven by the classical clinico-pathological factors like tumor stage, patient's age and performance status 20 which may be insufficient.…”

<p>Long Intergenic Non-Protein Coding RNA 519 Promotes the Biological Activities of Tongue Squamous Cell Carcinoma by Sponging microRNA-876-3p and Consequently Upregulating MACC1</p>

“…Unfortunately, the clinical outcomes of patients with TSCC remain unsatisfying and are mainly attributed to rapid tumor progression. 4 Despite numerous scientific studies of basic cellular activity in TSCC, [5][6][7] the detailed molecular events involved in TSCC carcinogenesis and progression are largely elusive. Therefore, a complete recognition of the mechanisms underlying TSCC pathogenesis is urgently needed, as this may be useful in the identification of potential therapeutic targets.…”