Annals of Surgical Oncology

, Volume 17, Issue 4, pp 1118–1126 | Cite as

Outcome Analysis of Patients with pN2 Oral Cavity Cancer

  • Chun-Ta Liao
  • Shiang-Fu Huang
  • I-How Chen
  • Chung-Jan Kang
  • Chien-Yu Lin
  • Kang-Hsing Fan
  • Hung-Ming Wang
  • Shu-Hang Ng
  • Chuen Hsueh
  • Li-Yu Lee
  • Chung-Kan Tsao
  • Tzu-Chen Yen
Head and Neck Oncology

Abstract

Background

The American Joint Committee on Cancer staging system suggests that squamous-cell carcinoma of the oral cavity (OSCC) with pN2 should be classified as stage IVA. The objective of the current study was to determine the outcome of patients with pN2 OSCC cancer according to different T status.

Methods

Between January 1996 and September 2007, a total of 270 patients with pN2 OSCC cancer were analyzed. All participants had a follow-up of at least 2 years or were censored on the date of last follow-up. The outcome measures for this study were the 5-year rates of locoregional control, distant metastases, and survival.

Results

Five-year disease-specific survival and overall survival rates in pT1 (n = 9), pT2 (n = 98), pT3 (n = 70), and pT4 (n = 93) patients were 78%, 66%, 49%, 35% (P = 0.0031), and 78%, 52%, 35%, 23% (P = 0.0001), respectively. Multivariable analysis revealed that pT3–4, level IV/V metastases, extracapsular spread, and poor differentiation were independent risk factors for 5-year disease-specific survival in the entire study cohort. Specific independent prognostic factors for 5-year disease-specific survival according to T stage were found.

Conclusions

The results of this study suggest that patients with pN2 OSCC cancer have different outcomes and prognostic factors according to their T status. In the light of these findings, treatment strategies may be quite different.

References

  1. 1.
    Woolgar JA. Histopathological prognosticators in oral and oropharyngeal squamous cell carcinoma. Oral Oncol. 2006;42:229–39.CrossRefPubMedGoogle Scholar
  2. 2.
    Cooper JS, Pajak TF, Forastiere AA, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med. 2004;350:1937–44.CrossRefPubMedGoogle Scholar
  3. 3.
    Bernier J, Domenge C, Ozsahin M, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med. 2004;350:1945–52.CrossRefPubMedGoogle Scholar
  4. 4.
    Bernier J, Cooper JS, Pajak TF, et al. D efining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (#9501). Head Neck. 2005;27:843–50.CrossRefPubMedGoogle Scholar
  5. 5.
    Liao CT, Chang JT, Wang HM, et al. Surgical outcome of T4a and resected T4b oral cavity cancer. Cancer. 2006;107:337–44.CrossRefPubMedGoogle Scholar
  6. 6.
    Liao CT, Chang JT, Wang HM, et al. Survival in squamous cell carcinoma of the oral cavity: differences between pT4N0 and other stage IVA categories. Cancer. 2007;110:564–71.CrossRefPubMedGoogle Scholar
  7. 7.
    Liao CT, Wang HM, Chang JT, et al. Analysis of risk factors for distant metastases in squamous cell carcinoma of the oral cavity. Cancer. 2007;110:1501–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Liao CT, Chang JT, Wang HM, et al. Analysis of risk factors predictive of local tumor control in oral cavity cancer. Ann Surg Oncol. 2008;15:915–22.CrossRefPubMedGoogle Scholar
  9. 9.
    Fleming ID, Cooper JS, Henson DE, et al., editors. AJCC cancer staging manual. 5th ed. Philadelphia: Lippincott-Raven; 1997.Google Scholar
  10. 10.
    Greene FL, Page DL, Fleming ID, Fritz AG, Balch CM, editors. AJCC cancer staging manual. 6th ed. New York: Springer-Verlag; 2002.Google Scholar
  11. 11.
    Liao CT, Ng SH, Chang JT, et al. T4b oral cavity cancer below the mandibular notch is resectable with a favorable outcome. Oral Oncol. 2007;43:570–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Bachaud JM, Cohen-Jonathan E, Alzieu C, et al. Combined postoperative radiotherapy and weekly cisplatin infusion for locally advanced head and neck carcinoma: final report of a randomized trial. Int J Radiat Oncol Biol Phys. 1996;36:999–1004.PubMedGoogle Scholar
  13. 13.
    Wang HM, Wang CS, Chen JS, et al. Cisplatin, tegafur, and leucovorin: a moderately effective and minimally toxic outpatient neoadjuvant chemotherapy for locally advanced squamous cell carcinoma of the head and neck. Cancer. 2002;94:2989–95.CrossRefPubMedGoogle Scholar
  14. 14.
    Kowalski LP, Bagietto R, Lara JRL, et al. Prognostic significance of the distribution of neck node metastasis from oral carcinoma. Head Neck. 2000;22:207–14.CrossRefPubMedGoogle Scholar
  15. 15.
    Gil Z, Carlson DL, Boyle JO, et al. Lymph node density is a significant predictor of outcome in patients with oral cancer. Cancer. 2009;115:5700–10.CrossRefPubMedGoogle Scholar
  16. 16.
    Rogers SN, Brown JS, Woolgar JA, et al. Survival following primary surgery for oral cancer. Oral Oncol. 2009;45:201–11.CrossRefPubMedGoogle Scholar
  17. 17.
    Garzino-Demo P, Dell’acqua A, Dalmasso P, et al. Clinicopathological parameters and outcome of 245 patients operated for oral squamous cell carcinoma. J Craniomaxillofac Surg. 2006;34:344–50.PubMedGoogle Scholar
  18. 18.
    Woolgar JA, Rogers SN, Lowe D, Brown JS, Vaughan ED. Cervical lymph node metastasis in oral cancer: the importance of even microscopic extracapsular spread. Oral Oncol. 2003;39:130–7.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Chun-Ta Liao
    • 1
    • 2
  • Shiang-Fu Huang
    • 1
    • 2
  • I-How Chen
    • 1
    • 2
  • Chung-Jan Kang
    • 1
    • 2
  • Chien-Yu Lin
    • 2
    • 3
  • Kang-Hsing Fan
    • 2
    • 3
  • Hung-Ming Wang
    • 2
    • 4
  • Shu-Hang Ng
    • 2
    • 5
  • Chuen Hsueh
    • 2
    • 6
  • Li-Yu Lee
    • 2
    • 6
  • Chung-Kan Tsao
    • 2
    • 7
  • Tzu-Chen Yen
    • 2
    • 8
    • 9
  1. 1.Department of Otorhinolaryngology, Head and Neck SurgeryChang Gung Memorial Hospital and Chang Gung University at LinkoTaoyuanTaiwan, ROC
  2. 2.Department of Head and Neck Oncology GroupChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan, ROC
  3. 3.Department of Radiation OncologyChang Gung Memorial Hospital and Graduate Institute of Clinical Medical Sciences of Chang Gung UniversityTaoyuanTaiwan, ROC
  4. 4.Department of Hema-OncologyChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan, ROC
  5. 5.Department of Diagnostic RadiologyChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan, ROC
  6. 6.Department of PathologyChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan, ROC
  7. 7.Department of Plastic and Reconstructive SurgeryChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan, ROC
  8. 8.Nuclear Medicine and Molecular Imaging CenterChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan, ROC
  9. 9.Department of Nuclear MedicineChang Gung Memorial Hospital at LinkoTaoyuanTaiwan, ROC

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