Abstract
MethodsWe sought to compare the prognostic impact of tumor differentiation with respect to adverse risk factors (RFs) identified by the National Comprehensive Cancer Network (NCCN) guidelines––including extranodal extension (ENE), positive/close margins, perineural invasion, lymphatic invasion, and vascular invasion––in patients with locally advanced oral cavity squamous cell carcinoma (OCSCC).ResultsBetween 1996 and 2018, 1179 consecutive patients with first primary pT3–4 OCSCC were included. A three‐level grading system was adopted––in which the final classification was assigned according to the most prevalent tumor grade. We identified 382/669/128 patients with well/moderately/poorly differentiated tumors, respectively. Compared with well/moderately differentiated tumors, poorly differentiated OCSCC had a higher prevalence of the following variables: female sex (4%/6%/11%), ENE, (14%/36%/61%), positive margins (0.5%/2%/4%), close margins (10%/14%/22%), perineural invasion (22%/50%/63%), lymphatic invasion (2%/9%/17%), vascular invasion (1%/4%/10%), and adjuvant therapy (64%/80%/87%). The 5‐year rates of patients with well/moderately/poorly differentiated OCSCC were as follows: local control (LC, 85%/82%/84%, p = 0.439), neck control (NC, 91%/83%/70%, p < 0.001), distant metastases (DM, 6%/18%/40%, p < 0.001), disease‐free survival (DFS, 78%/63%/46%, p < 0.001), disease‐specific survival (DSS, 85%/71%/49%, p < 0.001), and overall survival (OS, 68%/55%/39%, p < 0.001). Multivariable analysis identified the following variables as independent prognosticators for 5‐year outcomes: ENE (LC/NC/DM/DFS/DSS/OS), poorly differentiated tumors (NC/DM/DFS/DSS/OS), positive margins (LC/DFS), lymphatic invasion (DFS/DSS/OS), perineural invasion (DM), and age ≥65 years (OS).ConclusionsIn addition to ENE, poor tumor differentiation was identified as the second most relevant adverse RF for patients with pT3–4 OCSCC. We suggest that the NCCN guidelines should include poor tumor differentiation as an adverse RF to refine and tailor clinical management.
Highlights
Surgery––either with or without adjuvant therapy–– remains the mainstay of treatment for oral cavity squamous cell carcinoma (OCSCC).1 Clinical outcomes of patients with OCSCC are driven by locoregional control, and radical surgical excision is of paramount importance for achieving a favorable prognosis.2 As for neck control, level I–III and I–V neck dissections (NDs) are recommended for patients with cN0 and cN+ diseases, respectively
We retrospectively reviewed the clinical records of all consecutive patients with first primary pT3–4 OCSCC (n = 1179) who were consecutively referred to the Chang Gung Memorial Hospital between January 1996 and December 2018
The presence of poor tumor differentiation had an adverse impact on all survival endpoints (i.e., disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS))
Summary
Surgery––either with or without adjuvant therapy–– remains the mainstay of treatment for oral cavity squamous cell carcinoma (OCSCC). Clinical outcomes of patients with OCSCC are driven by locoregional control, and radical surgical excision is of paramount importance for achieving a favorable prognosis. As for neck control, level I–III and I–V neck dissections (NDs) are recommended for patients with cN0 and cN+ diseases, respectively. The National Comprehensive Cancer Network (NCCN) treatment guidelines have identified several adverse histopathological parameters for patients with OCSCC–– including ENE, positive margins, margins
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