The Impact of Post-Operative Radiotherapy in Early Stage (pT1-pT2N0M0) Oral Tongue Squamous Cell Carcinoma in Era of DOI

Alterio, Daniela; D’Urso, Pasqualina; Volpe, Stefania; Tagliabue, Marta; Berardinis, Rita De; Augugliaro, Matteo; Gandini, Sara; Maffini, Fausto; Bruschini, Roberto; Turturici, Irene; Riccio, Stefano; Calabrese, Luca; Farneti, Alessia; Starzyńska, Anna; Ferrari, Annamaria; Jereczek‐Fossa, Barbara Alicja; Ansarin, Mohssen; Sanguineti, Giuseppe

doi:10.3390/cancers13194851

Cited by 9 publications

(9 citation statements)

References 19 publications

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“…Rajappa et al 29 demonstrated that the addition of PORT on the basis of DOI did not show significant survival benefits in pT1-2N0M0 OTSCC. Similar results were also obtained by Alterio et al 14 and Rubin et al 30 Conversely, Liao et al 25 margin ≥5 mm is commonly considered adequate in OTSCC, 20 yet alternative proposals by Zanoni et al 20 and Tasche et al 23 suggest cutoffs of 2.2 mm and 1 mm for improved risk stratification in oral cancer, respectively. Conversely, some authors found no association between margin status and local recurrence in T1-2N0 oral cancer.…”

Section: Discussionsupporting

confidence: 71%

“…6,7 In deed, the clinical benefit of PORT in patients with early-stage OTSCC is highly controversial, 12,13 with uncertain risk factors. [14][15][16][17][18][19] In the absence of a definitive randomized clinical trial, a large retrospective study may be helpful. This study, which included the largest cohort (528 cases) of patients with pT1-2N0M0 OTSCC, aimed to evaluate the role of PORT in early-stage OTSCC and identify subgroups that may benefit from PORT.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Postoperative Radiotherapy on the Prognosis of Early-Stage (pT1-2N0M0) Oral Tongue Squamous Cell Carcinoma

Tian,

Jiang,

Dai

et al. 2024

JCO

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PURPOSE To identify subgroups of patients with early-stage (pT1-2N0M0) oral tongue squamous cell carcinoma (OTSCC) who may benefit from postoperative radiotherapy (PORT). PATIENTS AND METHODS This retrospective cohort study included 528 patients diagnosed between October 2009 and December 2021. Clinicopathological characteristics and treatments with or without PORT were analyzed for their impact on outcomes. RESULTS Among 528 patients who underwent radical surgery (median age, 62 years [IQR, 52-69]), 145 (27.5%) also underwent PORT. Multivariate analyses revealed that PORT was associated with improved survival outcomes, whereas moderate-to-poor differentiation, perineural infiltration (PNI), lymphovascular invasion (LVI), and increasing depth of invasion (DOI) were associated with poorer survival outcomes. For patients with moderate-to-poor differentiation, the surgery + PORT group showed improved outcomes compared with the surgery-alone group. After propensity score matching, the results were as follows: overall survival (OS), 97% versus 69%, P = .003; disease-free survival (DFS), 88% versus 50%, P = .001. After excluding cases with PNI/LVI, the differences persisted: OS, 97% versus 82%, P = .040; DFS, 87% versus 64%, P = .012. Similar survival benefits were observed in 104 patients with PNI and/or LVI (OS, 81% v 58%; P = .022; DFS, 76% v 47%; P = .002). In subgroups with DOI >5 mm or close margins, PORT contributed to improved DFS (80% v 64%; P = .006; 92% v 66%; P = .049) but did not significantly affect OS. CONCLUSION Patients with moderately-to-poorly differentiated pT1-2N0M0 OTSCC benefited from PORT. Our study provided evidence that patients with PNI and/or LVI who underwent PORT had improved survival. PORT also offered DFS benefit among patients with DOI >5 mm.

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Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Impact of Postoperative Radiotherapy on the Prognosis of Early-Stage (pT1-2N0M0) Oral Tongue Squamous Cell Carcinoma

Tian,

Jiang,

Dai

et al. 2024

JCO

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“…Thus, the uniformity of indications for postoperative therapies did not seem to be influenced by the T migration of the TNM system, since the final pathological staging is impacted by the status of N in the case of ECE+ 20 .…”

Section: Discussionmentioning

confidence: 96%

Oral tongue carcinoma: prognostic changes according to the updated 2020 version of the AJCC/UICC TNM staging system

Tagliabue

Berardinis

Belloni

et al. 2022

Acta Otorhinolaryngol Ital

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SUMMARY Background This study aimed to evaluate the performance of the 2017 8 th TNM edition and the latest update in 2020 compared to the 7 th in a large cohort of patients affected by oral tongue squamous cell carcinoma (OTSCC), considering all stages. Materials and methods The cohort involved 300 patients affected by OTSCC treated with surgery. All cases were classified according to the 7 th , 8 th (2017), and the latest updated TNM edition (October 2020),. Patients were grouped based on the shift in tumour (T) category, lymph nodal (N) category and final pathological stage. Overall survival (OS) and disease-free survival (DFS) were calculated with the Kaplan-Meier method. Univariate and multivariate analyses were carried out. Results According to the 7 th edition, multivariate analysis OS revealed that stage IV patients had an almost 4-fold risk of death compared to stage I (HR = 3.81 95% CI: 2.32-6.25; p < 0.001). Regarding DFS, stage IV patients had a 2-fold greater risk of relapses, or second primary, than patients in stage I (HR = 2.51 95% CI: 1.68-3.74; p < 0.001). According to 2017 8 th edition for OS, stage IV patients presented a 5-fold higher risk of death compared to patients in stage I (HR = 5.18 95% CI: 2.96-9.08; p < 0.001) and almost 4-old greater risk of relapses or second primary compared to patients in stage I considering DFS (HR = 3.61 95% CI: 2.28-5.71; p < 0.001). Regarding the recent edition of 8 th TNM (2020), stage IV patients had an almost 5-fold greater risk of death compared to patients in stage I considering OS (HR = 4.84 95% CI: 2.74-8.55; p < 0.001), while for DFS they had 3-fold greater risk of relapse or second primary compared to patients in stage I (HR = 3.13 95% CI: 1.99-4.91; p < 0.001). Conclusions This study confirmed that the recent update of the 8th edition of the TNM (2020) improves stratification and identification of advanced tumours, reducing the number of T3 compared to the 2017 edition and increasing the number of patients with pT4. This improvement made by the updated edition may reduce the risk of skipping adjuvant therapy.

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“…These factors are known prognostic factors in oral cancer ( 66 , 67 ), but, to date, their role has not yet been evaluated in terms of the difference between men and women.…”

Section: Discussionmentioning

confidence: 99%

The prognostic role of sex and hemoglobin levels in patients with oral tongue squamous cell carcinoma

Tagliabue

D’Ecclesiis²,

Berardinis³

et al. 2022

Front. Oncol.

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BackgroundWomen and men differ genetically, biologically (sex) and by social construct (gender), possibly impacting on prognostic factors in predicting cancer survival. Hemoglobin levels and immune system activation are players acting in this scenario which could play a role in partly determining prognosis between patients of different sex/gender (S/G). Here, we investigate these factors in patients affected by tongue squamous cell carcinoma.MethodsThis is an observational retrospective cohort study. We collected tongue cancer patients’ clinical data, including hemoglobin levels and neutrophil lymphocyte ratio (NLR). Overall survival (OS) and disease-free survival (DFS) were compared between women and men considering confounding and prognostic factors in multivariate Cox proportional hazard models. Stratified analyses were also conducted by sex and tumor stage.Result576 patients, 39.9% women and 60.1% men, were found eligible for the analysis. Men were more often smokers (p<0.001), alcohol consumers (p<0.001), overweight or obese (p<0.001) and undergoing radiotherapy (p=0.002). In multivariate models for stage I-II, men showed half risk of death and relapse compared to women (HR=0.44; 95%CI 0.24-0.81, p=0.009; HR=0.55; 95%CI 0.34-0.87, p=0.01, for OS and DFS respectively). Moreover, low hemoglobin levels appeared to be an independent prognostic factor for women but not for men in terms of both OS and DFS. Specifically, women with low hemoglobin levels showed a worse tumor outcome (HR=2.66; 95%CI 1.50-4.70; HR=2.09; 95%CI 1.24-3.53, for OS and DFS respectively). Low hemoglobin levels appeared to be a poor OS prognostic factor for women at stage I-II (p<0.004) but not for men (p=0.10). Women with advanced stage tumors, NLR>2.37, who did not performed Radiotherapy and with depth of invasion (DOI)> 10 were associated with a significant increase in relapse and death (all p<0.05).ConclusionIn our cohort of patients with oral tongue squamous cell carcinoma, men present better OS and DFS than women with early stages tumors. Low hemoglobin level was an independent prognostic factor for women, especially at early-stage tumors. For advanced stages (III-IV), sex is not a significant factor related to patients’ prognosis.

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The Impact of Post-Operative Radiotherapy in Early Stage (pT1-pT2N0M0) Oral Tongue Squamous Cell Carcinoma in Era of DOI

Cited by 9 publications

References 19 publications

Impact of Postoperative Radiotherapy on the Prognosis of Early-Stage (pT1-2N0M0) Oral Tongue Squamous Cell Carcinoma

Impact of Postoperative Radiotherapy on the Prognosis of Early-Stage (pT1-2N0M0) Oral Tongue Squamous Cell Carcinoma

Oral tongue carcinoma: prognostic changes according to the updated 2020 version of the AJCC/UICC TNM staging system

The prognostic role of sex and hemoglobin levels in patients with oral tongue squamous cell carcinoma

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