Annals of Surgical Oncology

, Volume 24, Issue 3, pp 785–793

Clinical Outcomes of Taiwanese Patients with cT4 Oral Cavity Squamous Cell Carcinoma: Toward the Identification of the Optimal Initial Treatment Approach for cT4b Patients

  • Chun-Ta Liao
  • Yu-Wen Wen
  • Shu Ru Lee
  • Tsang-Wu Liu
  • Sen-Tien Tsai
  • Ming-Hsui Tsai
  • Jin-Ching Lin
  • Pei-Jen Lou
  • Pen-Yuan Chu
  • Yi-Shing Leu
  • Kuo-Yang Tsai
  • Shyuang-Der Terng
  • Tsung-Ming Chen
  • Cheng-Hsu Wang
  • Chih-Yen Chien
  • Wen-Cheng Chen
  • Li-Yu Lee
  • Chien-Yu Lin
  • Hung-Ming Wang
  • Shu-Hang Ng
  • Chih-Hung Lin
  • Tuan-Jen Fang
  • Shiang-Fu Huang
  • Chung-Jan Kang
  • Kai-Ping Chang
  • Lan Yan Yang
  • Tzu-Chen Yen
  • for the Taiwan Oral Cancer Advisory Group
Head and Neck Oncology

DOI: 10.1245/s10434-016-5629-x

Cite this article as:
Liao, CT., Wen, YW., Lee, S.R. et al. Ann Surg Oncol (2017) 24: 785. doi:10.1245/s10434-016-5629-x
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Abstract

Background

The National Comprehensive Cancer Network guidelines recommend that patients with oral cavity squamous cell carcinoma (OSCC) and cT4b disease should be either included in clinical trials or treated with a nonsurgical approach. However, surgery may be feasible in selected patients with adequate safety margins. Using the nationwide Taiwanese Cancer Registry Database, we examined the prognosis of cT4b OSCC patients in relation to their treatment approach.

Methods

Of the 18,910 patients with previously untreated first primary OSCC identified between 2004 and 2010, 492 (2.6 %) had cT4b tumors. Of them, 327 (66 %) received initial treatment with surgery, whereas 165 (34 %) were initially treated with a nonsurgical approach. Of the latter group, 78 patients subsequently underwent surgery. A 5-year disease-specific survival (DSS) ≥45 % was considered as a favorable outcome.

Results

Better 5-year DSS and overall survival (OS) rates were observed in cT4b patients initially treated with surgery (vs. nonsurgery; DSS, 51 vs. 38 %; OS, 43 vs. 27 %, respectively, p < 0.001). Of the participants initially treated with surgery, patients with cN0–2 disease had better 5-year survival rates (DSS: cN0, 59 %; cN1, 53 %; cN2, 46 %; OS: cN0, 49 %; cN1, 50 %; cN2, 37 %) than those with cN3 disease (DSS: 0 %; OS: 0 %). Among cT4b patients who initially received a nonsurgical treatment, subjects who subsequently underwent surgery showed better outcomes.

Conclusions

Primary surgery is performed in approximately two-thirds of cT4b OSCC patients, with cN0–2 cases showing a good prognosis. Patients who initially received a nonsurgical approach can subsequently be treated with surgery and achieve favorable outcomes.

Supplementary material

10434_2016_5629_MOESM1_ESM.doc (28 kb)
Supplementary material 1 (DOC 28 kb)
10434_2016_5629_MOESM2_ESM.doc (32 kb)
Supplementary material 2 (DOC 32 kb)
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Supplementary material 3 (DOC 32 kb)
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Supplement Fig. 1Kaplan-Meier plots of 5-year survival endpoints stratified according to the cN classification and the initial treatment approach (surgery versus non-surgery). Disease-specific survival for cT4a tumors (panel A); overall survival for cT4a tumors (panel B); disease-specific survival for cT4b tumors (panel C); and overall survival for cT4b tumors (panel D). Supplementary material 4 (TIFF 23143 kb)
10434_2016_5629_MOESM5_ESM.tif (13.1 mb)
Supplement Fig. 2Multivariate Cox regression analysis of overall survival in patients with cT4b (panel A) and cT4a (panel B) tumors. Supplementary material 5 (TIFF 13465 kb)

Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Chun-Ta Liao
    • 1
  • Yu-Wen Wen
    • 2
  • Shu Ru Lee
    • 2
  • Tsang-Wu Liu
    • 3
  • Sen-Tien Tsai
    • 4
  • Ming-Hsui Tsai
    • 5
  • Jin-Ching Lin
    • 6
  • Pei-Jen Lou
    • 7
  • Pen-Yuan Chu
    • 8
  • Yi-Shing Leu
    • 9
  • Kuo-Yang Tsai
    • 10
  • Shyuang-Der Terng
    • 11
  • Tsung-Ming Chen
    • 12
  • Cheng-Hsu Wang
    • 13
  • Chih-Yen Chien
    • 14
  • Wen-Cheng Chen
    • 15
  • Li-Yu Lee
    • 16
  • Chien-Yu Lin
    • 17
  • Hung-Ming Wang
    • 18
  • Shu-Hang Ng
    • 19
  • Chih-Hung Lin
    • 20
  • Tuan-Jen Fang
    • 1
  • Shiang-Fu Huang
    • 1
  • Chung-Jan Kang
    • 1
  • Kai-Ping Chang
    • 1
  • Lan Yan Yang
    • 21
  • Tzu-Chen Yen
    • 22
  • for the Taiwan Oral Cancer Advisory Group
  1. 1.Department of Otorhinolaryngology, Head and Neck SurgeryChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
  2. 2.Clinical Informatics and Medical Statistics Research CenterChang Gung UniversityTaoyuanTaiwan
  3. 3.National Institute of Cancer ResearchNational Health Research InstitutesMiaoli CountyTaiwan
  4. 4.Department of Otolaryngology, College of Medicine, National Cheng Kung University HospitalNational Cheng Kung UniversityTainanTaiwan
  5. 5.Department of Otorhinolaryngology, Head and Neck SurgeryChina Medical University HospitalTaichungTaiwan
  6. 6.Department of Radiation OncologyTaichung Veterans General HospitalTaichungTaiwan
  7. 7.Department of Otolaryngology, College of MedicineNational Taiwan University HospitalTaipeiTaiwan
  8. 8.Department of OtolaryngologyTaipei Veterans General HospitalTaipeiTaiwan
  9. 9.Department of OtolaryngologyMackay Memorial HospitalTaipeiTaiwan
  10. 10.Department of Oral and Maxillofacial Surgery, Head and Neck SurgeryChanghua Christian HospitalChanghuaTaiwan
  11. 11.Department of Head and Neck SurgeryKoo Foundation Sun Yat-Sen Cancer CenterTaipeiTaiwan
  12. 12.Department of Otolaryngology-Head and Neck Surgery, Shuang Ho HospitalTaipei Medical UniversityTaipeiTaiwan
  13. 13.Division of Hematology/Oncology, Department of Internal MedicineChang Gung Memorial HospitalKeelungTaiwan
  14. 14.Department of Otolaryngology, College of Medicine, Chang Gung Memorial Hospital–Kaohsiung Medical CenterChang Gung UniversityTaoyuanTaiwan
  15. 15.Department of Radiation OncologyChang Gung Memorial HospitalChiayiTaiwan
  16. 16.Department of PathologyChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
  17. 17.Department of Radiation OncologyChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
  18. 18.Department of Medical OncologyChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
  19. 19.Department of Diagnostic RadiologyChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
  20. 20.Department of Plastic and Reconstructive SurgeryChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
  21. 21.Biostatistics and Informatics Unit, Clinical Trial CenterChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
  22. 22.Department of Nuclear Medicine and Molecular Imaging CenterChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan