Prevost Alice, Poncet Hugo, Benvegnu Victor, Poulet Vinciane, Butterworth Jacqueline, Varazzani Andréa, Lauwers Frédéric, Delanoë Franck
Plastic and Maxillofacial Surgery Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, Toulouse, France.
Plastic and Maxillofacial Surgery Department, Lyon Sud Hospital, Hospices Civils de Lyon, Claude-Bernard Lyon 1 University, Pierre-Bénite, France.
PLoS One. 2025 Aug 25;20(8):e0330376. doi: 10.1371/journal.pone.0330376. eCollection 2025.
The curative surgical treatment of older patients with oral cavity squamous cell carcinoma (OCSCC) is often personalized by incorporating subjective decisions on age and frailty. We aimed to determine here whether real-world recommended treatment, following official French guidelines only, versus deviation from recommended treatment was beneficial for older patients with OCSCC. To do this, we performed a retrospective evaluation of patients >70 years managed for treatment of p16-negative OCSCC in our tertiary hospital center in France between 2007 and 2017. The association between postoperative morbidity and deviation from recommended treatment was analysed using multivariate logistic regression. Cox Proportional Hazards Regression assessed the associations between deviation from recommended treatment and both the hazard of recurrence and mortality within 5 years. We included 185 patients who were recommended surgical resection of OCSCC: n = 147/185 (79%) patients underwent the recommended treatment and 38/185 (21%) patients underwent deviation from recommended treatment. Patients who underwent deviation from recommended treatment had a significantly lower recurrence-free survival (p = 0.0005) and overall survival (p = 0.008). Deviation from recommended treatment was found independently associated with increased development of 3-month postoperative morbidity (adjusted odds ratio 2.63 [1.23-5.82]; p = 0.02) and increased risk of recurrence within 5 years (adjusted hazard ratio 1.79 [1.14-2.83]; p = 0.01). Deviation from recommended treatment was not found independently associated with increased risk of mortality within 5 years (1.35 [0.82-2.23]; p = 0.2). Overall, deviation from recommended treatment was associated with worse outcomes and so we have identified a decision-making process biased by undocumented and subjective evidence. Preoperative risk models therefore require further validation in older patients with OCSCC to define more appropriate treatment regimens.
老年口腔鳞状细胞癌（OCSCC）患者的根治性手术治疗通常通过纳入关于年龄和虚弱程度的主观决策来实现个性化。我们旨在确定，对于老年OCSCC患者，仅遵循法国官方指南的实际推荐治疗与偏离推荐治疗相比，哪种方式更有益。为此，我们对2007年至2017年期间在法国我们的三级医院中心接受治疗的年龄大于70岁的p16阴性OCSCC患者进行了回顾性评估。使用多变量逻辑回归分析术后发病率与偏离推荐治疗之间的关联。Cox比例风险回归评估了偏离推荐治疗与5年内复发风险和死亡率之间的关联。我们纳入了185例被推荐进行OCSCC手术切除的患者：147/185（79%）例患者接受了推荐治疗，38/185（21%）例患者偏离了推荐治疗。偏离推荐治疗的患者无复发生存率（p = 0.0005）和总生存率（p = 0.008）显著更低。发现偏离推荐治疗与术后3个月发病率增加独立相关（调整优势比2.63 [1.23 - 5.82]；p = 0.02）以及5年内复发风险增加相关（调整风险比1.79 [1.14 - 2.83]；p = 0.01）。未发现偏离推荐治疗与5年内死亡风险增加独立相关（1.35 [0.82 - 2.23]；p = 0.2）。总体而言，偏离推荐治疗与更差的结果相关，因此我们发现了一个受无记录的主观证据影响的决策过程。因此，术前风险模型需要在老年OCSCC患者中进一步验证，以确定更合适的治疗方案。
