Cancer Medicine (May 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

  • 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,
  • Tzu‐Chen Yen,
  • Chun‐Ta Liao

DOI
https://doi.org/10.1002/cam4.7127
Journal volume & issue
Vol. 13, no. 10
pp. n/a – n/a

Abstract

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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.

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