Institute of Head and Neck Studies and Education, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
Oral and Maxillofacial Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
J Oral Pathol Med. 2019 Mar;48(3):206-213. doi: 10.1111/jop.12815. Epub 2019 Jan 20.
Recurrence of oral squamous cell carcinoma (rOSCC) after primary treatment is associated with poor survival outcomes. Salvage treatment with further surgery, radiotherapy and chemotherapy has high morbidity, making patient selection crucial. However, in the recurrence setting, reliable stratification data are scarce. Decision-making in this context is consequently complex. We investigated factors influencing overall survival after rOSCC.
Retrospective cohort study of patients with rOSCC (n = 83) at the Queen Elizabeth Hospital Birmingham, UK between 2006 and 2016. Associations with overall survival were analysed using univariate and multivariate analyses to identify important clinical prognostic indicators.
Overall survival at 1 year was 32.5% and at 5 years was 18.1% after a median follow-up of 7.4 months. Multivariate analysis identified four independent predictors of overall survival following rOSCC: size of primary tumour (HR 2.077; 95% CI 1.034-4.172), extent of recurrent disease (HR 3.286; 95% CI 1.545-6.991), history of moderate alcohol consumption (HR 0.351; 95% CI 0.162-0.763), and close or positive margins at primary resection (HR 1.955; 95% CI 1.063-3.595).
We identified four key factors that help prognostication and risk stratification of rOSCC. Given the high morbidity associated with salvage treatment, we recommend that the multidisciplinary team (MDT) and the patient weigh these factors carefully when considering further treatment. Further investigation of the biology underlying these oncophenotypes may contribute to better patient stratification.
口腔鳞状细胞癌（OSCC）经初次治疗后复发与不良生存结局相关。进一步采用手术、放疗和化疗进行挽救性治疗具有较高的发病率，因此患者选择至关重要。然而，在复发背景下，可靠的分层数据稀缺。在这种情况下，决策较为复杂。我们研究了影响 OSCC 复发后总生存率的因素。
本研究是英国伯明翰伊丽莎白女王医院 2006 年至 2016 年间进行的一项 OSCC 复发患者回顾性队列研究（n=83）。采用单变量和多变量分析来分析与总生存率的相关性，以确定重要的临床预后指标。
中位随访 7.4 个月后，1 年总生存率为 32.5%，5 年总生存率为 18.1%。多变量分析确定了 OSCC 复发后总生存率的四个独立预测因素：原发肿瘤大小（HR 2.077；95%CI 1.034-4.172）、复发疾病范围（HR 3.286；95%CI 1.545-6.991）、中度饮酒史（HR 0.351；95%CI 0.162-0.763）和初次切除时的切缘接近或阳性（HR 1.955；95%CI 1.063-3.595）。
我们确定了四个有助于预测和分层 OSCC 复发的关键因素。鉴于挽救性治疗的高发病率，我们建议多学科团队（MDT）和患者在考虑进一步治疗时仔细权衡这些因素。进一步研究这些肿瘤表型的生物学基础可能有助于更好地进行患者分层。
