Lu Hsueh-Ju, Chiu Yu-Wei, Peng Chih-Yu, Tseng Hsien-Chun, Hsin Chung-Han, Chuang Chun-Yi, Fan Sheng, Huang Wei-Shiou, Yang Shun-Fa
Division of Hematology and Oncology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
Oral Dis. 2025 Mar;31(3):756-768. doi: 10.1111/odi.15123. Epub 2024 Sep 3.
One-third of head and neck squamous cell carcinomas are early-stage oral cavity squamous cell carcinomas (OCSCC). Despite a high curative rate, 20% of early-stage OCSCC patients do not achieve long-term survival. This study evaluates the role of adjuvant therapy (ADJ) in delaying disease progression and prolonging survival.
This single-institute retrospective cohort study enrolled 481 early-stage OCSCC patients, 16% (78/481) of whom received ADJ. It was reported according to the STROBE guidelines. Cox proportional hazards regression and Kaplan-Meier survival curves were employed to identify suitable candidates for ADJ.
The 5-year locoregional recurrence-free survival (LR-RFS) and overall survival rates were 73.2% and 84.9%, respectively. Positive margins and advanced depth of invasion (DOI) were independent predictors of LR-RFS. For patients with positive margins, adjuvant chemoradiotherapy (CRT) was superior to adjuvant radiotherapy alone in improving LR-RFS (hazard ratios for adjuvant CRT vs. none, 0.042; adjuvant radiotherapy alone vs. none, 0.702). Excluding positive margins, advanced DOI was the most critical factor in assessing the need for ADJ. Positive margins and advanced DOI were more appropriate criteria than EORTC 22931/RTOG 9501 for evaluating adjuvant CRT.
Adjuvant CRT was indicated for patients with positive margins and advanced DOI to improve survival outcomes.
头颈部鳞状细胞癌中有三分之一是早期口腔鳞状细胞癌（OCSCC）。尽管治愈率很高，但20%的早期OCSCC患者无法实现长期生存。本研究评估辅助治疗（ADJ）在延缓疾病进展和延长生存期方面的作用。
这项单机构回顾性队列研究纳入了481例早期OCSCC患者，其中16%（78/481）接受了ADJ。研究按照STROBE指南进行报告。采用Cox比例风险回归和Kaplan-Meier生存曲线来确定适合接受ADJ的患者。
5年局部区域无复发生存率（LR-RFS）和总生存率分别为73.2%和84.9%。切缘阳性和浸润深度（DOI）增加是LR-RFS的独立预测因素。对于切缘阳性的患者，辅助放化疗（CRT）在改善LR-RFS方面优于单纯辅助放疗（切缘阳性患者辅助CRT与不治疗相比的风险比为0.042；单纯辅助放疗与不治疗相比的风险比为0.702）。排除切缘阳性情况后，DOI增加是评估是否需要ADJ的最关键因素。切缘阳性和DOI增加比欧洲癌症研究与治疗组织（EORTC）22931/美国放射肿瘤学会（RTOG）9501更适合作为评估辅助CRT的标准。
切缘阳性和DOI增加的患者应接受辅助CRT以改善生存结局。
