Sood Rachit, Singh Chirom Amit, Panda Smriti, Kakkar Aanchal, Thakar Alok, Sikka Kapil, Kumar Rajeev, Singh Anup, Bhasker Suman, Biswas Ahitagni, Kaur Kavneet, Ramdulari Anjali V
Department of Otorhinolaryngology & Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
Department of Otorhinolaryngology & Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
Oral Oncol. 2025 Sep;168:107566. doi: 10.1016/j.oraloncology.2025.107566. Epub 2025 Aug 5.
Early stage constitutes around 40 % of all oral cavity squamous cell carcinoma (OSCC). While the role of adjuvant therapy in advanced cases is well established, its role in early-stage disease remains controversial and is institutional based. Despite treatment advances, the 5-year Disease Free Survival (DFS) falls short of 80 %.
An ambispective observational study was conducted on all early stage (pT, N) OSCC who underwent curative surgery of the primary and neck from 2019 to 2024 at a tertiary oncology care centre. Patients with a history of radiation, recurrence, neoadjuvant chemotherapy or positive margins were excluded. Primary outcomes were overall survival (OS) and disease-free survival (DFS). Secondary outcomes were factors associated with recurrence, radiation-induced toxicity, and quality of life.
1260 OSCC were operated during the study period. 357(28 %) were early stage, and 274 were eligible for analysis. 52(18.9 %) patients had recurrence. 3-year-OS was 92 % and 3-year-DFS was 74 %. Tongue subsite (p = 0.034), depth of invasion (DOI) > 5 mm (p = 0.012), and peri-neural Invasion (PNI) (p = 0.036) were significant predictors of recurrence on multi-variate analysis. On matched-pair analysis patients who received adjuvant radiotherapy had lower rates of recurrence (16.9 % vs 24.6 %, p = 0.2815). Odds of recurrence increased from low to intermediate to high Brandwein-Gensler score (OR - 0.54 vs 0.89 vs 1.54, p = 0.4332).
Tongue/FOM subsite, DOI > 5 mm, and PNI are aggressive features in early-stage OSCC. Adjuvant therapy can help to achieve improved disease control. There is a pressing need to establish definitive indications for adjuvant therapy in pT1-2, N0 OSCC.
早期口腔鳞状细胞癌（OSCC）约占所有口腔鳞状细胞癌的40%。虽然辅助治疗在晚期病例中的作用已得到充分确立，但其在早期疾病中的作用仍存在争议，且因机构而异。尽管治疗取得了进展，但5年无病生存率（DFS）仍低于80%。
对2019年至2024年在一家三级肿瘤护理中心接受原发灶和颈部根治性手术的所有早期（pT、N）OSCC患者进行了一项前瞻性观察研究。排除有放疗史、复发史、新辅助化疗史或切缘阳性的患者。主要结局是总生存期（OS）和无病生存期（DFS）。次要结局是与复发、放疗引起的毒性和生活质量相关的因素。
在研究期间，1260例OSCC患者接受了手术。357例（28%）为早期，274例符合分析条件。52例（18.9%）患者复发。3年总生存率为92%，三年无病生存率为74%。在多变量分析中，舌部亚部位（p = 0.034）、浸润深度（DOI）>5mm（p = 0.012）和神经周围浸润（PNI）（p = 0.036）是复发的重要预测因素。在配对分析中，接受辅助放疗的患者复发率较低（16.9%对24.6%，p = 0.2815）。复发几率从低到中再到高的Brandwein-Gensler评分逐渐增加（OR - 0.54对0.89对1.54，p = 0.4332）。
舌部/口底亚部位、DOI>5mm和PNI是早期OSCC的侵袭性特征。辅助治疗有助于实现更好的疾病控制。迫切需要为pT1-2、N0 OSCC建立辅助治疗的确切指征。
