Hua Chun-Hung, Lin Jin-Ching, Wen Yu-Wen, Kang Chung-Jan, Lin Chien-Yu, Ku Hsiu-Ying, Fan Kang-Hsing, Ng Shu-Hang, Lee Shu-Ru, Tsai Yao-Te, Chen Wen-Cheng, Lee Li-Yu, Chien Chih-Yen, Wang Cheng Ping, Che Tsung-Ming, Terng Shyuang-Der, Tsai Chi-Ying, Wang Hung-Ming, Hsieh Chia-Hsun, Yeh Chih-Hua, Lin Chih-Hung, Tsao Chung-Kan, Cheng Nai-Ming, Fang Tuan-Jen, Huang Shiang-Fu, Lee Li-Ang, Fang Ku-Hao, Wang Yu-Chien, Lin Wan-Ni, Hsin Li-Jen, Yen Tzu-Chen, Liao Chun-Ta
Department of Otorhinolaryngology, China Medical University Hospital Taichung Taiwan Republic of China.
Department of Radiation Oncology Changhua Christian Hospital Changhua Taiwan Republic of China.
Oral Oncol. 2025 Mar;162:107198. doi: 10.1016/j.oraloncology.2025.107198. Epub 2025 Jan 28.
The current NCCN guidelines advocate for the use of adjuvant radiotherapy (RT) or chemoradiotherapy (CRT) in pT3N0 oral cavity squamous cell carcinoma (OCSCC). Here, we sought to evaluate whether postoperative RT/CRT may confer a survival advantage in pT3N0 patients who lack adverse pathological features.
A dataset of 852 pT3N0 OCSCC patients treated between 2018 and 2021 was analyzed. Patients with adverse pathological features (i.e., positive margins, margins <5 mm, lymphovascular invasion, or perineural invasion) were excluded, leaving 235 eligible patients. The cohort was further refined by omitting 12 patients who received surgery plus chemotherapy and two cases who received RT doses <5000 cGy, resulting in two study groups: surgery alone (n = 131) and surgery plus RT/CRT (n = 90).
Baseline characteristics were comparable between groups, except for a higher proportion of buccal subsite (p = 0.0063) and female patients (p = 0.0495) in the surgery alone group. Kaplan-Meier analyses revealed no significant differences in 4-year disease-specific survival (DSS) (84.2 % versus 85.9 %, p = 0.8834) or overall survival (OS) (75.6 % versus 84.8 %, p = 0.2376). These findings were confirmed by multivariable analyses and remained consistent after propensity score matching (n = 74 per group), with similar survival outcomes between groups (4-year DSS, 90.7 % versus 83.2 %, p = 0.4020; 4-year OS, 87.0 % versus 81.9 %, p = 0.6121) CONCLUSIONS: For patients with pT3N0 OCSCC lacking adverse pathological features, the addition of adjuvant RT/CRT does not appear to confer a survival benefit over surgery alone.
当前美国国立综合癌症网络（NCCN）指南提倡对pT3N0口腔鳞状细胞癌（OCSCC）患者使用辅助放疗（RT）或放化疗（CRT）。在此，我们试图评估术后RT/CRT对缺乏不良病理特征的pT3N0患者是否能带来生存优势。
分析了2018年至2021年间接受治疗的852例pT3N0 OCSCC患者的数据集。排除具有不良病理特征（即切缘阳性、切缘<5毫米、淋巴管浸润或神经周围浸润）的患者，留下235例符合条件的患者。通过排除12例接受手术加化疗的患者和2例接受放疗剂量<5000厘戈瑞的患者，进一步细化队列，形成两个研究组：单纯手术组（n = 131）和手术加RT/CRT组（n = 90）。
两组间基线特征具有可比性，但单纯手术组中颊部亚部位患者比例较高（p = 0.0063），女性患者比例较高（p = 0.0495）。Kaplan-Meier分析显示，4年疾病特异性生存率（DSS）（84.2%对85.9%，p = 0.8834）或总生存率（OS）（75.6%对84.8%，p = 0.2376）无显著差异。多变量分析证实了这些结果，倾向评分匹配后（每组n = 74）结果仍然一致，两组生存结果相似（4年DSS，90.7%对83.2%，p = 0.4020；4年OS，87.0%对81.9%，p = 0.6121）。结论：对于缺乏不良病理特征的pT3N0 OCSCC患者，辅助RT/CRT相较于单纯手术似乎并未带来生存获益。
