Clinical outcome and prognostic factors in recurrent oral squamous cell carcinoma after primary surgical treatment: a retrospective study

Sven Zittel,Christian Freudlsperger,Oliver Ristow,Julius Moratin,Michael Engel,Karl Metzger,Dominik Horn,Jürgen Hoffmann,Jan Mrosek,Kolja Freier

doi:10.1007/s00784-021-04186-y

Abstract

ObjectivesSurvival for patients with recurrent oral squamous cell carcinoma is usually poor, and the most effective treatment has not yet been clearly defined. The present study evaluates the outcome in radiotherapy-naïve patients after recurrence of oral squamous cell carcinoma with respect to different treatment modalities including surgery, radiation, chemoradiation, and palliative treatment.Patients and methodsIn this retrospective study, we included all patients with primary oral squamous cell carcinoma who received exclusively surgical therapy between 2010 and 2020 and who suffered from locoregional recurrence in their follow-up. Patients with previous adjuvant therapy were excluded from this protocol. Clinical and pathological parameters were collected and statistically evaluated. Survival analysis was performed according to Kaplan–Meier. The primary endpoints were overall and progression-free survival in dependance of treatment strategy for recurrent tumors.ResultsOut of a total of 538 patients with surgically treated primary oral squamous cell carcinoma, 76 patients met the inclusion criteria. The mean follow-up was 38 ± 32 months. Patients who received surgically based therapy had a significantly better outcome in terms of disease-free survival (DFS) and overall survival (OS) (DFS p < 0.001; OS p < 0.001). The presence of regional metastases and a short disease-free interval (DFI) between primary and recurrent cancer were significant predictors for adverse outcomes (DFI p < 0.001).ConclusionWe recommend primary surgical therapy for radiotherapy-naïve patients with recurrent oral squamous cell carcinoma, supplemented by risk-adapted adjuvant therapy.Clinical relevanceSurgical therapy continues to play a central role in the treatment of radiotherapy-naïve patients with recurrent oral squamous cell carcinoma.

Highlights

Head and neck squamous cell carcinoma (HNSCC) is one of the most common cancer entities worldwide and belongs to the heterogeneous group of head and neck cancer [1,2,3].Within HNSCC, oral squamous cell carcinoma (OSCC) represents one of the most important subsites [4]
We identified 538 patients with a primary OSCC who received primary surgical treatment in our department from 2010 to 2020
Thirty-one (40.3%) patients included in this study had an indication for adjuvant therapy for the index tumor due to histopathological parameters but either rejected adjuvant treatment of their index tumor or were not eligible due to general condition

Summary

Introduction

Head and neck squamous cell carcinoma (HNSCC) is one of the most common cancer entities worldwide and belongs to the heterogeneous group of head and neck cancer [1,2,3].Within HNSCC, oral squamous cell carcinoma (OSCC) represents one of the most important subsites [4]. I.e., resection of the malignancy combined with elective neck dissection (END), is the most common modality for the primary treatment of OSCC. It is accompanied by adjuvant radiotherapy or radiochemotherapy according to the histopathological staging and the presence of risk factors [5, 6]. Tumor recurrence is a frequently observed problem and occurs in approximately 40–60% of cases [10,11,12,13] resulting in a poor overall survival [14].

Objectives

Methods

Results

Discussion

Conclusion