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Treatment type, location influence survival outcomes for oral cavity cancer
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Early stage oral cavity squamous cell cancer outcomes tended to vary according to patient demographics, tumor characteristics and treatment factors, according to the results of a retrospective analysis.
Neck dissection and treatment at academic or research centers improved survival outcomes, whereas positive margins and insurance through Medicaid or Medicare were associated with poor outcomes, results showed.
The treatment of early oral cavity squamous cell cancer (OCSCC) — which accounts for 60% of OCSCC diagnoses — has not changed substantially in several decades, and, thus, progress has been lacking, according to study background. The use of neck dissection in this setting also remains a topic of debate, the researchers wrote.
Benjamin L. Hudson, MD, of the Yale University School of Medicine, and colleagues used the National Cancer Data Base to identify 6,830 patients with stage I or II OCSCC who underwent surgery to evaluate population-level associations between treatment factors and survival. The mean age of the population was 61.7 years and 61.5% were male.
The National Cancer Data Base categorized patients as having positive margins — defined as the presence of microscopic residual tumor, macroscopic residual tumor or residual tumor otherwise unspecified — or negative margins, defined as having no residual tumor.
OS and 5-year survival served as the primary endpoints.
The 5-year survival rate was 69.7% (n = 4,760).
Results of a univariate analysis indicated neck dissection or treatment at academic/research or high case volume centers yielded improved OS; however, positive margins and the receipt of radiation therapy or chemotherapy were associated with poorer OS (P < .001 for all).
A greater proportion of patients who underwent neck dissection achieved 5-year survival among those with stage II disease (63.9% vs. 49.1%; P < .001) and stage I disease (78.3% vs. 74.2%; P = .001).
Further, patients with stage I disease who did not undergo radiation therapy demonstrated a higher 5-year survival rate than those who did (77.6% vs. 63.5%; P < .001). This association persisted to a lesser degree in patients with stage II disease (53.5% vs. 61.2%; P = .002).
In a multivariable analysis, researchers observed an association between positive margins (HR = 1.27; 95% CI, 1.03-1.75), radiation therapy (HR = 1.31; 95% CI, 1.16-1.49) and chemotherapy (HR = 1.34; 95% CI, 1.03-1.75) and poor survival outcomes. Patients treated at nonacademic centers (HR = 1.13; 95% CI, 1.01-1.26) and patients insured through Medicaid (HR = 1.96; 95% CI, 1.6-2.39) and Medicare (HR = 1.45; 95% CI, 1.25-1.69) also demonstrated worse survival.
However, neck dissection improved OS outcomes in the multivariable analysis (HR = 0.85; 95% CI, 0.76-0.94). Patients treated at academic centers underwent neck dissection more frequently than patients treated at nonacademic centers and were less likely to receive radiation therapy or have positive margins (P < .001 for all).
The researchers acknowledged several limitations to their study, including their inability to ascertain patient and physician factors related to surgical or adjuvant therapy treatment choices. Researchers also failed to include potentially important factors — including smoking status and tumor thickness — in the multivariable analysis due to data unavailability.
“The data shows that if you are able to achieve negative margins in these patients, they do better, and that is something partly under the control of the treatment team,” Hudson told JAMA in an interview posted on their website. “The data [also] shows that those treated at academic research programs have better survival, similar to results found with other types of cancer. That is a big area of interest in outcomes research.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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