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Clinical Outcomes of Taiwanese Patients with Resected Oral Cavity Squamous Cell Carcinoma Who Underwent Reconstruction with Free Versus Local Flaps

  • Reconstructive Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

We sought to compare the clinical outcomes of Taiwanese patients with resected oral cavity squamous cell carcinoma (OCSCC) who underwent reconstruction with free versus local flaps.

Methods

From 2011 to 2017, we examined 8646 patients with first primary OCSCC who received surgery either with or without adjuvant therapy. Of these patients, 7297 and 1349 received free and local flap reconstruction, respectively. Two propensity score-matched groups of patients who underwent free versus local flap (n = 1268 each) reconstructions were examined. Margin status was not included as a propensity score-matched variable.

Results

Compared with local flaps, patients who received free flaps had a higher prevalence of the following variables: male sex, age < 65 years, pT3−4, pN1−3, p-Stage III−IV, depth ≥ 10 mm, margin > 4 mm, extranodal extension (ENE), and adjuvant therapy (all p < 0.0001). Multivariable analysis identified the reconstruction method (local vs. free flaps, only overall survival [OS]), age ≥ 65 years, pT3−4, pN1−3, p-Stage III−IV, depth ≥ 10 mm (only OS), margins ≤ 4 mm, and ENE as independent adverse prognosticators for disease-specific survival (DSS) and OS. The results of propensity score-matched analyses revealed that, compared with free flaps, patients who underwent local flap reconstruction showed less favorable 5-year DSS (hazard ratio [HR] 1.26, 82%/77%; p = 0.0100) and OS (HR 1.21, 73%/68%; p = 0.0079).

Conclusions

After adjusting for covariates using multivariate models, and also by propensity score modeling, OCSCC patients who underwent free flap reconstruction showed a higher frequency of clear margins and a significant survival advantage compared with those who received local flaps.

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Acknowledgment

The authors wish to thank the Research Service Center for Health Information (Chang Gung University, Taiwan) for the valuable input in the study design, data management, and statistical analysis. They also acknowledge the kind assistance of the Oral Cancer Advisory Group, National Health Research Institute, Taiwan.

Funding

This research was financially supported by Grants CMRPD1H0521 and BMRPC55 from the Chang Gung Medical Research Program.

Author information

Author notes

  1. Chun-Ta Liao, Yu-Wen Wen, and ShuRu Lee have contributed equally to this work.

  2. Chih-Hung Lin and Lan Yan Yang share senior authorship.

Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan

    Chun-Ta Liao MD, Tuan-Jen Fang MD, Shiang-Fu Huang MD, PhD, Chung-Jan Kang MD, PhD & Kai-Ping Chang MD, PhD

  2. Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan

    Yu-Wen Wen PhD

  3. Research Service Center for Health Information, Chang Gung University, Taoyuan, Taiwan

    Shu-Ru Lee PhD

  4. Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan

    Shu-Hang Ng MD

  5. National Institute of Cancer Research, National Health Research Institutes, Miaoli, Taiwan

    Tsang-Wu Liu MD

  6. Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Sen-Tien Tsai MD

  7. Department of Otorhinolaryngology, Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan

    Ming-Hsui Tsai MD

  8. Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan

    Jin-Ching Lin MD, PhD

  9. Department of Otolaryngology, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan

    Chih-Yen Chien MD

  10. Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan

    Pei-Jen Lou MD, PhD & Cheng-Ping Wang MD

  11. Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan

    Pen-Yuan Chu MD

  12. Department of Otolaryngology, Mackay Memorial Hospital, Taipei, Taiwan

    Yi-Shing Leu MD

  13. Department of Oral and Maxillofacial Surgery, Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan

    Kuo-Yang Tsai MD

  14. Department of Head and Neck Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan

    Shyuang-Der Terng MD

  15. Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

    Tsung-Ming Chen MD

  16. Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan

    Cheng-Hsu Wang MD, PhD

  17. Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan

    Wen-Cheng Chen MD

  18. Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan

    Li-Yu Lee MD

  19. Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan

    Chien-Yu Lin MD, PhD

  20. Department of Medical Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan

    Hung-Ming Wang MD

  21. Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan

    Tzu-Chen Yen MD, PhD

  22. Biostatistics and Informatics Unit, Clinical Trial Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan

    Lan-Yan Yang PhD

  23. Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan

    Chih-Hung Lin MD

Authors
  1. Chun-Ta Liao MD
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Consortia

for the Taiwan Oral Cavity Cancer Advisory Group

Contributions

Study concept and design: C-TL, Y-WW, SRL, LYY, C-HL: Data analysis and interpretation: C-TL, Y-WW, SRL, LYY, C-HL: Manuscript drafting or critical revision for important intellectual content: All authors. Final approval of the manuscript: All authors. Agreement to be accountable for all aspects of the work: All authors.

Corresponding authors

Correspondence to Lan-Yan Yang PhD or Chih-Hung Lin MD.

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Chun-Ta Liao, Yu-Wen Wen, Shu Ru Lee, Shu-Hang Ng, Tsang-Wu Liu, Sen-Tien Tsai, Ming-Hsui Tsai, Jin-Ching Lin, Chih-Yen Chien, Pei-Jen Lou, Cheng Ping Wang, Pen-Yuan Chu, Yi-Shing Leu, Kuo-Yang Tsai, Shyuang-Der Terng, Tsung-Ming Chen, Cheng-Hsu Wang, Wen-Cheng Chen, Li-Yu Lee, Chien-Yu Lin, Hung-Ming Wang, Tuan-Jen Fang, Shiang-Fu Huang, Chung-Jan Kang, Kai-Ping Chang, Tzu-Chen Yen, Lan Yan Yang, and Chih-Hung Lin have no conflicts of interest to disclose.

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SUPPLEMENTARY FIG. 1

. Kaplan–Meier plots of 5-year (a) disease-specific and (b) overall survival in the entire study cohort of patients with resected oral cavity cancer who underwent reconstruction with free versus local flaps (TIF 1554 kb)

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Liao, CT., Wen, YW., Lee, SR. et al. Clinical Outcomes of Taiwanese Patients with Resected Oral Cavity Squamous Cell Carcinoma Who Underwent Reconstruction with Free Versus Local Flaps. Ann Surg Oncol 29, 1130–1140 (2022). https://doi.org/10.1245/s10434-021-10524-x

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