The Impact of Post-Operative Radiotherapy in Early Stage (pT1-pT2N0M0) Oral Tongue Squamous Cell Carcinoma in Era of DOI.

Daniela Alterio,Annamaria Ferrari,Anna Starzyńska,Roberto Bruschini,Irene Turturici,Luca Calabrese,Alessia Farneti,Stefania Volpe,Marta Tagliabue,Barbara Alicja Jereczek-Fossa,Giuseppe Sanguineti,Rita De Berardinis,Matteo Augugliaro,Fausto Antonio Maffini,Mohssen Ansarin,Sara Gandini,Stefano Riccio,Pasqualina D’Urso

doi:10.3390/cancers13194851

Abstract

Simple SummaryThe aim of the present study was to clarify the role of depth of infiltration (DOI) as an independent prognosticator in early stage (T1-T2N0M0) oral cavity tumors. Moreover, whether patients upstaged to pT3 for DOI > 10 mm need postoperative radiotherapy (PORT) in the absence of other risk factors has not been established yet. The DOI alone was not sufficient to impact the prognosis and therefore other risk factors should be considered to indicate PORT indications in upstaged patients due to DOI > 10 mm.Background: This study investigated the role of depth of infiltration (DOI) as an independent prognosticator in early stage (T1-T2N0M0) oral cavity tumors and to evaluate the need of postoperative radiotherapy in the case of patients upstaged to pT3 for DOI > 10 mm in the absence of other risk factors. Methods: We performed a retrospective analysis on patients treated with surgery and re-staged according to the 8th edition of malignant tumors classification (TNM). The role of DOI as well as other clinical/pathological features was investigated at both univariable and multivariable analyses on overall survival (OS), disease free survival (DFS), relapse free survival (RFS), and local RFS. Results: Among the 94 included patients, 23 would have been upstaged to pT3 based on DOI. Multivariable analysis showed that DOI was not an independent prognostic factor for any of the considered outcomes. The presence of perineural invasion was associated with a significant worse RFS (p = 0.02) and LRFS (p = 0.04). PORT was found to be significantly associated with DFS (p = 0.04) and RFS (p = 0.06). Conclusions: The increasing DOI alone was not sufficient to impact the prognosis, and therefore, should not be sufficient to dictate PORT indications in early-stage patients upstaged on the sole basis of DOI.

Highlights

Radical-intent surgery represents the standard treatment for oral tongue squamous cell carcinomas (OTSCCs) [1]
All other risk factors and Post-operative radiotherapy (PORT) were not found to be significantly associated with any of the considered oncological outcomes
The results of our analysis demonstrate that only PNI is an independent prognostic factor in early stage (T < 4 cm and N0) OTSCCs, considering depth of infiltration (DOI) along with other wellknown pathological tumor-related risk factors

Summary

Introduction

Radical-intent surgery represents the standard treatment for oral tongue squamous cell carcinomas (OTSCCs) [1]. DOI allowed us to improve discrimination among different stages, for small tumors, in the absence of any additional risk factors, DOI did not seem to improve the prediction of 5-year disease-specific mortality [3] This finding raises the question on the independent prognostic role of DOI when compared to the other already known pathologic prognosticators such as PNI, LVI, surgical margins, and tumor grading in this subset of patients. This study investigated the role of depth of infiltration (DOI) as an independent prognosticator in early stage (T1-T2N0M0) oral cavity tumors and to evaluate the need of postoperative radiotherapy in the case of patients upstaged to pT3 for DOI > 10 mm in the absence of other risk factors.

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