Department of Head and Neck Surgical Oncology, Mazumdar Shaw Cancer Center, Narayana Health, Bangalore, India.
Department of Radiodiagnosis and Imaging, Mazumdar Shaw Cancer Center, Narayana Health, Bangalore, India.
Oral Oncol. 2019 Aug;95:43-51. doi: 10.1016/j.oraloncology.2019.05.021. Epub 2019 Jun 6.
Current guidelines advocate non-surgical treatment for T4b buccal mucosa carcinoma with surgery preferred in other stages. We investigated oncologic outcomes of this cohort in comparison with T4a cohort, treated by similar multi-modality approach of primary surgery followed by adjuvant treatment and identified prognostic determinants of survival.
Oncologic outcome of prospectively accrued 282 patients with cT4a and cT4b buccal mucosa squamous cell carcinoma were evaluated for overall survival (OS) and disease free survival (DFS) at 2 years of the whole cohort and for the subgroups of T4a and T4b patients. Multivariate Cox proportional hazards regression analysis was performed to identify prognostic determinants.
Of 277 eligible patients treated and followed for a median period of 21 months, the OS was comparable between T4a and T4b as 64% vs 58%, (p = 0.354). The DFS between the two subgroups was 64% vs 61%, (p = 0.316). Although there was 47% pathologic down staging from the clinical stage, there was no significant difference in oncologic outcome between pT4a and pT4b (OS, 57% vs 58% for T4a and T4b, p = 0.687; DFS, 58% vs 60% for T4a and T4b, p = 0.776). On multivariate analysis, extra capsular spread (p = 0.042), lateral pterygoid muscle involvement (p = 0.035) and defaulting adjuvant treatment (p < 0.001) were independent predictors of outcome for the T4b cohort when other factors were controlled.
Primary surgery followed by adjuvant chemo-radiotherapy offers comparable results in selected T4b gingiva and buccal mucosal cancer, suggesting the need to relook the staging criteria for oral cavity cancer.
目前的指南主张对 T4b 颊黏膜癌进行非手术治疗，而在其他阶段则首选手术。我们研究了这一组患者的肿瘤学结果，并与接受类似多模式治疗（原发性手术加辅助治疗）的 T4a 组进行了比较，并确定了生存的预后决定因素。
对 282 例 T4a 和 T4b 颊黏膜鳞状细胞癌患者的前瞻性资料进行了评估，评估了全队列的总生存（OS）和无病生存（DFS），以及 T4a 和 T4b 患者亚组的生存情况。采用多变量 Cox 比例风险回归分析来确定预后决定因素。
在 277 例符合条件的患者中，中位随访时间为 21 个月，T4a 和 T4b 的 OS 相当，分别为 64%和 58%（p=0.354）。两个亚组之间的DFS 分别为 64%和 61%（p=0.316）。尽管临床分期有 47%的病理性降期，但 pT4a 和 pT4b 的肿瘤学结果没有显著差异（OS，T4a 和 T4b 分别为 57%和 58%，p=0.687；DFS，T4a 和 T4b 分别为 58%和 60%，p=0.776）。多因素分析显示，包膜外扩散（p=0.042）、翼内肌侵犯（p=0.035）和辅助治疗失约（p<0.001）是 T4b 组的独立预后因素，其他因素得到控制。
原发性手术加辅助放化疗在选择的 T4b 牙龈和颊黏膜癌中提供了可比较的结果，这表明需要重新审视口腔癌的分期标准。
