Comparing the clinical outcomes of initial surgery and primary definitive radiotherapy with a dosage of 6600 cGy or higher in cT1−2N0M0 oral cavity squamous cell carcinoma: A nationwide cohort study

Chien Yu Lin, Wen Cheng Chen, Yu Wen Wen, Kang Hsing Fan, Jin Ching Lin, Shu Hang Ng, Yao Te Tsai, Shu Ru Lee, Chung Jan Kang, Li Yu Lee, Chih Yen Chien, Chun Hung Hua, Cheng Ping Wang, Tsung Ming Chen, Shyuang Der Terng, Chi Ying Tsai, Hung Ming Wang, Chia Hsun Hsieh, Chih Hua Yeh, Chih Hung LinChung Kan Tsao, Nai Ming Cheng, Tuan-Jen Fang, Shiang Fu Huang, Li Ang Lee, Ku Hao Fang, Yu Chien Wang, Wan Ni Lin, Li Jen Hsin, Tzu Chen Yen, Chun Ta Liao*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

Abstract

BACKGROUND: To compare the clinical outcomes of two treatment modalities, initial surgery and primary definitive radiotherapy (RT), in Taiwanese patients diagnosed with cT1-2N0M0 oral cavity squamous cell carcinoma (OCSCC).

METHODS: Between 2011 and 2019, we analyzed data for 13,542 cT1-2N0M0 patients who underwent initial surgery (n = 13,542) or definitive RT with a dosage of at least 6600 cGy (n = 145) for the treatment of OCSCC. To account for baseline differences, we employed propensity score (PS) matching, resulting in two well-balanced study groups (initial surgery, n = 580; definitive RT, n = 145).

RESULTS: Before PS matching, the 5-year disease-specific survival (DSS) rates were 88% for the surgery group and 58% for the RT group. After PS matching, the 5-year DSS rates of the two groups were 86% and 58%, respectively. Similarly, the 5-year overall survival (OS) rates before PS matching were 80% for the surgery group and 36% for the RT group, whereas after PS matching, they were 73% and 36%, respectively. All these differences were statistically significant (p < 0.0001). A multivariable analysis identified treatment with RT, older age, stage II tumors, and a higher burden of comorbidities as independent risk factors for both DSS and OS. We also examined the 5-year outcomes for various subgroups (margin ≥5 mm, margin <5 mm, positive margins, RT combined with chemotherapy, and RT alone) as follows: DSS, 89%/88%/79%/63%/51%, respectively, p < 0.0001; OS, 82%/79%/68%/39%/32%, respectively, p < 0.0001.

CONCLUSIONS: In Taiwanese patients with cT1-2N0M0 OCSCC, a remarkably low proportion (1.1%) completed definitive RT. A significant survival disparity of 30% was observed between patients who underwent initial surgery and those who received definitive RT. Interestingly, even patients from the surgical group with positive surgical margins exhibited a significantly superior survival compared to those in the definitive RT group.

Original languageEnglish
Article numbere7127
Pages (from-to)e7127
JournalCancer Medicine
Volume13
Issue number10
DOIs
StatePublished - 05 2024

Bibliographical note

© 2024 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Keywords

  • cancer registry
  • clinical outcomes
  • cT1−2N0M0
  • definite radiotherapy
  • oral cavity squamous cell carcinoma
  • surgery
  • Radiotherapy Dosage
  • Squamous Cell Carcinoma of Head and Neck/radiotherapy
  • Humans
  • Middle Aged
  • Male
  • Treatment Outcome
  • Carcinoma, Squamous Cell/radiotherapy
  • Survival Rate
  • Mouth Neoplasms/radiotherapy
  • Taiwan/epidemiology
  • Propensity Score
  • Female
  • Adult
  • Aged
  • Retrospective Studies
  • Neoplasm Staging

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