Abstract
Objective: Second primary tumours (SPT) have been implicated in the dismal overall survival (OS) of head and neck Squamous cell carcinomas (HNSCC). The incidence of SPT, the SPT diagnostic time-lag and the impact on OS were assessed. Subjects and methods: 363 consecutive patients treated for primary Oral SCCs (1967-2004) were analyzed retrospectively in this study. 95.1% and 90.5% of patients reached a minimum follow-up period of 3 and 5 years respectively. Results: Of 363 patients; 68 (18.7%) were diagnosed with metachronous SPT, 49 (13.5%) developed upper aerodigestive tract (UAD)-SPT, 28 (7.7%) were diagnosed with HNSCC-SPT, and 21 (5.8%) developed lung or esophageal carcinoma. Patients with subsequent HNSCC-SPT had a better median survival during follow-up than those not diagnosed with SPTs (p=0.0018). The rate of mortality in these patients showed a substantial increase compared to patients with no subsequent SPT Diagnosis after 144 months. After 200 months the survival experience was no better than those without SPT. Conclusion: These results suggest a better OS for patients afflicted with HNSCC-SPT. This also reflects that at least some of the noted improved OS of HNSCC-SPT patients is due to temporally cumulated risk associated with developing SPT.
Highlights
Head and neck squamous cell carcinoma (HNSCC) incidence, morbidity and mortality remain a serious public health issue
The field cancerisation theory first put forward by Slaughter asserts that repeated exposure of the upper aerodigestive (UAD) mucosa to carcinogens, tobacco and alcohol, result in independent neoplastic tissues along the tract that are separated by site and time [7]
Three-hundred and sixty-three patients diagnosed and treated for primary oral squamous cell carcinoma (OSCC) were included in this study
Summary
Head and neck squamous cell carcinoma (HNSCC) incidence, morbidity and mortality remain a serious public health issue. Treatment and accessible anatomical surveillance, oral squamous cell carcinoma (OSCC) continues to have poor outcomes including poor overall survival (OS) [1]. Reports of SPT incidence vary from 2-30% [2,3,4,5,6]. These involve the upper aerodigestive (UAD) tract as well as remote sites. The field cancerisation theory first put forward by Slaughter asserts that repeated exposure of the UAD mucosa to carcinogens, tobacco and alcohol, result in independent neoplastic tissues along the tract that are separated by site and time [7]. Many previous reports have either lacked adequate follow-up or have suffered from inconsistencies in diagnostic criteria and patient selection [8]
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