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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2017

01-03-2017 | Head and Neck Oncology

Clinical Outcomes of Taiwanese Patients with cT4 Oral Cavity Squamous Cell Carcinoma: Toward the Identification of the Optimal Initial Treatment Approach for cT4b Patients

Authors: Chun-Ta Liao, MD, Yu-Wen Wen, PhD, Shu Ru Lee, PhD, Tsang-Wu Liu, MD, Sen-Tien Tsai, MD, Ming-Hsui Tsai, MD, Jin-Ching Lin, MD, Pei-Jen Lou, MD, PhD, Pen-Yuan Chu, MD, Yi-Shing Leu, MD, Kuo-Yang Tsai, MD, Shyuang-Der Terng, MD, Tsung-Ming Chen, MD, Cheng-Hsu Wang, MD, Chih-Yen Chien, MD, Wen-Cheng Chen, MD, Li-Yu Lee, MD, Chien-Yu Lin, MD, PhD, Hung-Ming Wang, MD, Shu-Hang Ng, MD, Chih-Hung Lin, MD, Tuan-Jen Fang, MD, Shiang-Fu Huang, MD, PhD, Chung-Jan Kang, MD, Kai-Ping Chang, MD, PhD, Lan Yan Yang, PhD, Tzu-Chen Yen, MD, PhD, for the Taiwan Oral Cancer Advisory Group

Published in: Annals of Surgical Oncology | Issue 3/2017

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Abstract

Background

The National Comprehensive Cancer Network guidelines recommend that patients with oral cavity squamous cell carcinoma (OSCC) and cT4b disease should be either included in clinical trials or treated with a nonsurgical approach. However, surgery may be feasible in selected patients with adequate safety margins. Using the nationwide Taiwanese Cancer Registry Database, we examined the prognosis of cT4b OSCC patients in relation to their treatment approach.

Methods

Of the 18,910 patients with previously untreated first primary OSCC identified between 2004 and 2010, 492 (2.6 %) had cT4b tumors. Of them, 327 (66 %) received initial treatment with surgery, whereas 165 (34 %) were initially treated with a nonsurgical approach. Of the latter group, 78 patients subsequently underwent surgery. A 5-year disease-specific survival (DSS) ≥45 % was considered as a favorable outcome.

Results

Better 5-year DSS and overall survival (OS) rates were observed in cT4b patients initially treated with surgery (vs. nonsurgery; DSS, 51 vs. 38 %; OS, 43 vs. 27 %, respectively, p < 0.001). Of the participants initially treated with surgery, patients with cN0–2 disease had better 5-year survival rates (DSS: cN0, 59 %; cN1, 53 %; cN2, 46 %; OS: cN0, 49 %; cN1, 50 %; cN2, 37 %) than those with cN3 disease (DSS: 0 %; OS: 0 %). Among cT4b patients who initially received a nonsurgical treatment, subjects who subsequently underwent surgery showed better outcomes.

Conclusions

Primary surgery is performed in approximately two-thirds of cT4b OSCC patients, with cN0–2 cases showing a good prognosis. Patients who initially received a nonsurgical approach can subsequently be treated with surgery and achieve favorable outcomes.
Appendix
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Metadata
Title
Clinical Outcomes of Taiwanese Patients with cT4 Oral Cavity Squamous Cell Carcinoma: Toward the Identification of the Optimal Initial Treatment Approach for cT4b Patients
Authors
Chun-Ta Liao, MD
Yu-Wen Wen, PhD
Shu Ru Lee, PhD
Tsang-Wu Liu, MD
Sen-Tien Tsai, MD
Ming-Hsui Tsai, MD
Jin-Ching Lin, MD
Pei-Jen Lou, MD, PhD
Pen-Yuan Chu, MD
Yi-Shing Leu, MD
Kuo-Yang Tsai, MD
Shyuang-Der Terng, MD
Tsung-Ming Chen, MD
Cheng-Hsu Wang, MD
Chih-Yen Chien, MD
Wen-Cheng Chen, MD
Li-Yu Lee, MD
Chien-Yu Lin, MD, PhD
Hung-Ming Wang, MD
Shu-Hang Ng, MD
Chih-Hung Lin, MD
Tuan-Jen Fang, MD
Shiang-Fu Huang, MD, PhD
Chung-Jan Kang, MD
Kai-Ping Chang, MD, PhD
Lan Yan Yang, PhD
Tzu-Chen Yen, MD, PhD
for the Taiwan Oral Cancer Advisory Group
Publication date
01-03-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 3/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5629-x

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