Abstract

BackgroundStandardized staging procedures and presentation of oral squamous cell carcinoma (OSCC) patients in multidisciplinary tumor boards (MDTB) before treatment and utilization of elective neck dissection (ND) are expected to improve the outcome, especially in local advanced LAOSCC (UICC stages III–IVB). As standardized diagnostics but also increased heterogeneity in treatment applied so far have not been demonstrated to improve outcome in LAOSCC, a retrospective study was initiated.MethodsAs MDTB was introduced into clinical routine in 2007, 316 LAOSCC patients treated during 1991-2017 in our hospital were stratified into cohort 1 treated before (n=104) and cohort 2 since 2007 (n=212). Clinical characteristics, diagnostic procedures and treatment modality of patients were compared using Chi-square tests and outcome analyzed applying Kaplan-Meier plots and log-rank tests as well as Cox proportional hazard regression. Propensity scores (PS) were used to elucidate predictors for impaired distant metastasis-free survival (DMFS) in PS-matched patients.ResultsMost patient characteristics and treatment modalities applied showed insignificant alteration. Surgical treatment included significantly more often resection of the primary tumor plus neck dissection, tracheostomy and percutaneous endoscopic gastrostomy tube use. Cisplatin-based chemo-radiotherapy was the most frequent. Only insignificant improved disease- (DFS), progression- (PFS) and event-free (EFS) as well as tumor-specific (TSS) and overall survival (OS) were found after 2006 as local (LC) and loco-regional control (LRC) were significantly improved but DMFS significantly impaired. Cox regression applied to PS-matched patients elucidated N3, belonging to cohort 2 and cisplatin-based chemo-radiotherapy as independent predictors for shortened DMFS. The along chemo-radiotherapy increased dexamethasone use in cohort 2 correlates with increased DM.ConclusionsDespite standardized diagnostic procedures, decision-making considering clear indications and improved therapy algorithms leading to improved LC and LRC, shortened DMFS hypothetically linked to increased dexamethasone use had a detrimental effect on TSS and OS.

Highlights

  • Surgery followed by postoperative radio- (Op+PORT) or platinum-based concomitant radio-chemotherapy (Op +PORCT) represent the recommended standard of care in local and/or loco-regional advanced oral squamous cell carcinoma (LAOSCC) in Germany

  • The information provided in pathology reports since 2007 was more comprehensive and in all cases treated by surgical resection included data about the number of analyzed neck nodes, resection margins as well as information about perineural (Pn1), lymphatic (L1) or vascular infiltration (V1) of the primary lesion or absence of those (Pn0, L0, and V0, respectively)

  • In line with increased use of neck dissection, the number of neck nodes examined increased from 10.1 (6.9-13.4) to 26.9 (23.9-29.9; p=4.4∙10-12) and led to increased numbers of N+ identified in cohort 2 (2.0, 95% CI 1.6-2.4) compared to cohort 1 (1.1, 95% CI 0.8-1.4; p=0.0003)

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Summary

Introduction

Surgery followed by postoperative radio- (Op+PORT) or platinum-based concomitant radio-chemotherapy (Op +PORCT) represent the recommended standard of care in local and/or loco-regional advanced oral squamous cell carcinoma (LAOSCC) in Germany. Our aim was to assess outcome differences before and after introduction of standardized diagnostic workup and patient-centered decision making for surgery and neck dissection followed by risk-factor adapted adjuvant therapy that was simultaneously implemented by establishing our MDTB. Standardized staging procedures and presentation of oral squamous cell carcinoma (OSCC) patients in multidisciplinary tumor boards (MDTB) before treatment and utilization of elective neck dissection (ND) are expected to improve the outcome, especially in local advanced LAOSCC (UICC stages III–IVB). As standardized diagnostics and increased heterogeneity in treatment applied so far have not been demonstrated to improve outcome in LAOSCC, a retrospective study was initiated

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