Time patterns of recurrence and second primary tumors in a large cohort of patients treated for oral cavity cancer

Abstract

Introduction Routine follow‐up after curative treatment of patients with oral squamous cell carcinoma (OSCC) is common practice considering the high risk of second primaries and recurrences (ie second events). Current guidelines advocate a follow‐up period of at least 5 years. The recommendations are not evidence‐based and benefits are unclear. This is even more so for follow‐up after a second event. To facilitate the development of an evidence‐ and personalized follow‐up program for OSCC, we investigated the course of time until the second and subsequent events and studied the risk factors related to these events. Materials and methods We retrospectively studied 594 OSCC patients treated with curative intent at the Head and Neck Cancer Unit of the Radboud University Medical Centre from 2000 to 2012. Risk of recurrence was calculated addressing death from intercurrent diseases as competing event. Results The 1‐, 5‐ and 10‐year cumulative risks of a second event were 17% (95% CI:14%;20%), 30% (95% CI:26%;33%), and 37% (95% CI:32%;41%). Almost all locoregional recurrences occurred in the first 2 years after treatment. The incidence of second primary tumors was relatively stable over the years. The time pattern of presentation of third events was similar. Discussion Our findings support a follow‐up time of 2 years after curative treatment for OSCC. Based on the risk of recurrence there is no indication for a different follow‐up protocol after first and second events. After 2 years, follow‐up should be tailored to the individual needs of patients for supportive care, and monitoring of late side‐effects of treatment.

Point‐of‐care oral cytology tool for the screening and assessment of potentially malignant oral lesions

“…A cell identification tool to assist in the accurate and precise estimation of histopathological endpoints for the entire spectrum of OED and OSCC was developed. Figure shows the diagnostic categories and rates for oral cancer and dysplasia based on the World Health Organization classification found during mass screening, demonstrating 5‐year malignant transformations and 5‐year cancer recurrence rates . The literature presents a range of 5‐year transformation and recurrence rates, and we believe the ones listed herein are representative of those reported previously …”

Follow‐up after oral cancer treatment—Transition to a personalized approach

“…The five year cumulative risk of a second event after surgical treatment of OC in a Dutch cohort of OSCC patients was assessed based on treatment type, previous malignancy, tumour location, whether the patient underwent a neck dissection, the presence of extracapsular spread and the presence of vaso-invasive growth. 12 Other authors have developed models to predict overall survival in OC and HNC patients based on clinical parameters such as WHO performance score, T-and N-stage, socioeconomic status score, age and gender, weight loss, BMI and smoking status. 20 Another way of personalizing follow-up is by selecting patients who will not have any curative treatment options left.…”

“…21 The parameters of this model are similar to the model developed in the Dutch cohort which predicted treatment in OC patients on the basis of tumour size, nodal status, previous treatment, invasion depth and ASA score. 12 These models will need further validation in other patient populations, but appear to be a useful instrument in selecting patients who may or may not benefit from routine follow-up.…”

“…5,10,11 The most important one being ending follow-up after two years as most recurrences occur within this timespan. 12,13 Furthermore, in practice, follow-up protocols are not strictly followed, as some clinicians apply a form of risk stratification based on patient-and tumour factors. 10,14 In addition, compliance to routine follow-up is expected to differ between patients.…”

Describing Clinical and Histological Outcome of Oral Cancer Patients with Recurrent Malignant or Premalignant Oral Lesions: A Retrospective Series with a Follow-Up of 15 Years

“…Relapse for head and neck squamous cell carcinoma varies from 16% to 52% [2]. Patients with primary tumor diagnosis also have a higher chance to develop second primary tumors (SPTs), arising further than 2 cm from the primary site and/or 5 years later than primary diagnosis, due to an independent carcinogenesis leading to the onset of a new tumor [1,2]. Aim of the present study was to review retrospectively, from 2003 to 2018, how many patients, firstly diagnosed with an oral malignant neoplasm, experienced a subsequent malignant and/or premalignant disorder, in the form of new OPMD, cancerized OPMD, relapsed cancer or SPT.…”