Ramirez-Guanche Noëmi, Jaeken Fien, Di Santo Davide, Nuyts Sandra, Clement Paul M, Laenen Annousschka, Meulemans Jeroen, Vander Poorten Vincent
Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.
Department of Oncology, Section of Head and Neck Oncology, Catholic University Leuven, Leuven, Belgium.
Front Surg. 2025 Jul 24;12:1610776. doi: 10.3389/fsurg.2025.1610776. eCollection 2025.
Head and neck cancer (HNC) is the third most common cancer worldwide, with oral squamous cell carcinoma (OSCC) having the highest incidence. Despite early diagnosis in 50% of cases, recurrence and poor survival remain concerns. This study compares survival outcomes between primary and second primary cT1-T2 OSCC.
A single-center historical cohort study included 60 patients treated for cT1-T2 OSCC between 2010 and 2022. Patient demographics, tumor characteristics, and treatment modalities were collected. Treatment followed ESMO guidelines, primarily involving surgery with or without postoperative radiotherapy. Kaplan-Meier analysis and Cox proportional hazards models assessed overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS).
The 2- and 5-year OS rates were 85% and 64.9%, while DSS rates were 91.4% and 87.3%, respectively. Median OS was 7.4 years. Patients with primary tumors had significantly better OS (HR = 0.409, = 0.038) and DFS (HR = 0.399, = 0.036) than those with second primary tumors. Female patients had a 74.7% lower risk of death, and males had significantly shorter DFS ( = 0.024). Advancing tumor stage increased disease-specific mortality risk (HR = 1.737, = 0.043). Multiple lymph node involvement correlated with worse OS (HR = 2.884, = 0.031) and DFS (HR = 3.971, = 0.006). Gross extranodal extension (ENE) was significantly associated with poorer OS ( = 0.048) and showed a borderline association with DFS ( = 0.050).
This study confirms second primary malignancies as a key prognostic factor for survival in OSCC. Male sex, advanced TNM stage, gross ENE, multiple lymph node involvement, and active smoking status were linked to poorer outcomes. Larger studies with multivariate analysis comparing primary and non-primary tumors are needed to validate these findings.
头颈癌（HNC）是全球第三大常见癌症，其中口腔鳞状细胞癌（OSCC）发病率最高。尽管50%的病例能够早期诊断，但复发和低生存率仍是令人担忧的问题。本研究比较了原发性和第二原发性cT1-T2 OSCC的生存结果。
一项单中心历史队列研究纳入了2010年至2022年间接受cT1-T2 OSCC治疗的60例患者。收集了患者的人口统计学信息、肿瘤特征和治疗方式。治疗遵循欧洲肿瘤内科学会（ESMO）指南，主要包括手术及术后放疗（有或无）。采用Kaplan-Meier分析和Cox比例风险模型评估总生存期（OS）、疾病特异性生存期（DSS）和无病生存期（DFS）。
2年和5年的OS率分别为85%和64.9%，而DSS率分别为91.4%和87.3%。OS的中位数为7.4年。原发性肿瘤患者的OS（HR = 0.409，P = 0.038）和DFS（HR = 0.399，P = 0.036）显著优于第二原发性肿瘤患者。女性患者死亡风险降低74.7%，男性患者的DFS显著缩短（P = 0.024）。肿瘤分期进展增加了疾病特异性死亡风险（HR = 1.737，P = 0.043）。多个淋巴结受累与较差的OS（HR = 2.884，P = 0.031）和DFS（HR = 3.971，P = 0.006）相关。大体淋巴结外扩展（ENE）与较差的OS显著相关（P = 0.048），与DFS有边缘性关联（P = 0.050）。
本研究证实第二原发性恶性肿瘤是OSCC生存的关键预后因素。男性、晚期TNM分期、大体ENE、多个淋巴结受累和现患吸烟状态与较差的预后相关。需要进行更大规模的多变量分析研究，比较原发性和非原发性肿瘤，以验证这些发现。
