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Peeping Beyond TNM Stage: Prognostic Factors Affecting Oncological Outcomes in Surgically Treated Early Oral Cancer

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Abstract

Surgery is the primary modality for the treatment of early oral cancer. The present study aims to evaluate the oncological outcomes, patterns of failure, and prognostic predictors of recurrence in patients of early oral cancer (Stage I and II) treated by surgery alone. It is a single institutional, observational retrospective cohort study conducted from 2012 to 2017.The study was approved by institutional ethics committee. All consecutive patients who underwent upfront curative surgery alone (wide excision of tumour + neck dissection) for pathologically proven early oral cavity SCC(Squamous Cell Carcinoma) pT1-2N0 were included in the study. 113 patients were included in the study after a median follow-up of 58.2 months. The median age was 58.5 years. 25 patients were stage I, and 88 patients were stage II. The most common subsite was buccal mucosa. There were 31 recurrences and 24 deaths. Using Kaplan Meier method, 3 and 5 year overall survival was 92% and 71.8%, respectively, while 3 year and 5 year recurrence-free survival was 77.9% and 69.4%, respectively. Perineural invasion and poor differentiation affected recurrence-free survival significantly (p value < 0.05). More than one-fourth of surgically treated early oral SCC patients developed recurrence. Presence of poorly differentiated histology and the perineural invasion were the high risk factors which hampered the recurrence free survival. High consumption of betel quid consumption in this part of the world leads to differences in the involved subsite from the Western literature. Adding adjuvant treatment in the presence of these adverse histopathological features may improve prognosis. Randomised studies are warranted to answer this dilemma.

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Acknowledgements

Dr. Anupam Das and Dr. Kirti Khandelwal were responsible for the concept of this paper, wrote the manuscript and made the figure and table outlines. All other authors provided valuable feedback, suggestions and corrections to improve the quality of the manuscript. All the authors gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

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  1. Head and Neck Surgery, Dr. B. Borooah Cancer Institute, Guwahati, Assam, 781016, India

    Anupam Das, Kishore Das, Kaberi Kakati, Kirti Khandelwal, Tashnin Rahman & Rajjyoti Das

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  1. Anupam Das
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Correspondence to Kirti Khandelwal.

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Das, A., Das, K., Kakati, K. et al. Peeping Beyond TNM Stage: Prognostic Factors Affecting Oncological Outcomes in Surgically Treated Early Oral Cancer. Indian J Otolaryngol Head Neck Surg 76, 552–558 (2024). https://doi.org/10.1007/s12070-023-04211-4

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