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 Lin; Chung 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; Tzue-Chen Yen; Chun Ta Liao

doi:10.1002/cam4.7127

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, Tzue-Chen Yen, Chun Ta Liao^*

^*Corresponding author for this work

Department of Biomedical Sciences (Master's Program in Clinical Trials Assessment)

Research output: Contribution to journal › Journal 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 language	English
Article number	e7127
Pages (from-to)	e7127
Journal	Cancer Medicine
Volume	13
Issue number	10
DOIs	https://doi.org/10.1002/cam4.7127
State	Published - 05 2024

Bibliographical note

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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1002/cam4.7127

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Lin, C. Y., Chen, W.-C., Wen, Y. W., Fan, K. H., Lin, J. C., Ng, S. H., Tsai, Y. T., Lee, S. R., Kang, C. J., Lee, L. Y., Chien, C. Y., Hua, C. H., Wang, C. P., Chen, T. M., Terng, S. D., Tsai, C. Y., Wang, H. M., Hsieh, C. H., Yeh, C. H., ... Liao, C. T. (2024). 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. Cancer Medicine, 13(10), e7127. Article e7127. https://doi.org/10.1002/cam4.7127

@article{9bff3aa7ad224cd1b70be3293a571ddd,

title = "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",

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.",

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",

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

note = "{\textcopyright} 2024 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.",

year = "2024",

month = may,

doi = "10.1002/cam4.7127",

language = "英语",

volume = "13",

pages = "e7127",

journal = "Cancer Medicine",

issn = "2045-7634",

publisher = "John Wiley and Sons Inc",

number = "10",

}

Lin, CY, Chen, W-C, Wen, YW, Fan, KH, Lin, JC, Ng, SH, Tsai, YT, Lee, SR, Kang, CJ, Lee, LY, Chien, CY, Hua, CH, Wang, CP, Chen, TM, Terng, SD, Tsai, CY, Wang, HM, Hsieh, CH, Yeh, CH, Lin, CH, Tsao, CK, Cheng, NM, Fang, TJ, Huang, SF , Lee, LA, Fang, KH, Wang, YC, Lin, WN, Hsin, LJ, Yen, T-C & Liao, CT 2024, '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', Cancer Medicine, vol. 13, no. 10, e7127, pp. e7127. https://doi.org/10.1002/cam4.7127

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. / Lin, Chien Yu; Chen, Wen-Cheng; Wen, Yu Wen et al.
In: Cancer Medicine, Vol. 13, No. 10, e7127, 05.2024, p. e7127.

Research output: Contribution to journal › Journal Article › peer-review

TY - JOUR

T1 - 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

T2 - A nationwide cohort study

AU - Lin, Chien Yu

AU - Chen, Wen-Cheng

AU - Wen, Yu Wen

AU - Fan, Kang Hsing

AU - Lin, Jin Ching

AU - Ng, Shu Hang

AU - Tsai, Yao Te

AU - Lee, Shu Ru

AU - Kang, Chung Jan

AU - Lee, Li Yu

AU - Chien, Chih Yen

AU - Hua, Chun Hung

AU - Wang, Cheng Ping

AU - Chen, Tsung Ming

AU - Terng, Shyuang Der

AU - Tsai, Chi Ying

AU - Wang, Hung Ming

AU - Hsieh, Chia Hsun

AU - Yeh, Chih Hua

AU - Lin, Chih Hung

AU - Tsao, Chung Kan

AU - Cheng, Nai Ming

AU - Fang, Tuan Jen

AU - Huang, Shiang Fu

AU - Lee, Li Ang

AU - Fang, Ku Hao

AU - Wang, Yu Chien

AU - Lin, Wan Ni

AU - Hsin, Li Jen

AU - Yen, Tzue-Chen

AU - Liao, Chun Ta

PY - 2024/5

Y1 - 2024/5

N2 - 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.

AB - 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.

KW - cancer registry

KW - clinical outcomes

KW - cT1−2N0M0

KW - definite radiotherapy

KW - oral cavity squamous cell carcinoma

KW - surgery

KW - Radiotherapy Dosage

KW - Squamous Cell Carcinoma of Head and Neck/radiotherapy

KW - Humans

KW - Middle Aged

KW - Male

KW - Treatment Outcome

KW - Carcinoma, Squamous Cell/radiotherapy

KW - Survival Rate

KW - Mouth Neoplasms/radiotherapy

KW - Taiwan/epidemiology

KW - Propensity Score

KW - Female

KW - Adult

KW - Aged

KW - Retrospective Studies

KW - Neoplasm Staging

UR - http://www.scopus.com/inward/record.url?scp=85193685143&partnerID=8YFLogxK

U2 - 10.1002/cam4.7127

DO - 10.1002/cam4.7127

M3 - 文章

C2 - 38770540

AN - SCOPUS:85193685143

SN - 2045-7634

VL - 13

SP - e7127

JO - Cancer Medicine

JF - Cancer Medicine

IS - 10

M1 - e7127

ER -

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

Abstract

Bibliographical note

Keywords

UN SDGs

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