Oral Cancer in the Indian Subcontinent-Survival Outcomes and Risk Factors with Primary Surgery

Alok Thakar; Rishikesh Thakur; Aanchal Kakkar; Rajeev Kumar Malhotra; Chirom Amit Singh; Kapil Sikka; Rajeev Kumar; Raja Pramanik; Ahitagni Biswas; Ashu Seith Bhalla; Suman Bhaskar; Atul Sharma

doi:10.1002/lary.29537

Oral Cancer in the Indian Subcontinent-Survival Outcomes and Risk Factors with Primary Surgery

Laryngoscope. 2021 Oct;131(10):2254-2261. doi: 10.1002/lary.29537. Epub 2021 Apr 1.

Authors

Affiliations

¹ Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
² Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
³ Delhi Cancer Registry, BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
⁴ Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India.
⁵ Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.
⁶ Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.

PMID: 33797083
DOI: 10.1002/lary.29537

Abstract

Objective: To assess the oncological outcome and prognostic factors for primary Oral Squamous Cell Cancer (OSCC) staged as per AJCC 8th pTNM, and treated by the contemporary standard of primary surgery and pathology directed adjuvant radiation-chemoradiation.

Methods: A single institution cohort from a tertiary care academic institution in North India. Case inclusion 2013 to 2016; n = 218, median follow-up 35 months. All patients were restaged as per the AJCC 8th pTNM classification. Analysis for Overall Survival (OS), Disease-free Survival(DFS), and factors impacting outcome (Cox proportionate model Multivariate analysis).

Results: AJCC pTNM 7th to 8th edition conversion led to upstaging in 16.5%. Stage-II demonstrated greatest stage migration and apparent improvement in OS and DFS (P < .09). Discordance was noted between the presurgical (clinico-radiologic) and postsurgical (pathological) nodal status in 40.3% (88/218; 54 pathologically upstaged;34 downstaged). Pathological downstaging was particularly significant with advanced stage Gingivo-Buccal Cancers (25/73-34.7%). Stage-I-II early cancers had 3 years. OS-86.7% and DFS-78.8%; Stage-III-IV advanced cancers had 3 years. OS-56.7% and DFS-46.6%. Multivariate analysis identified poorer OS and DFS for age < 40 years (HR-1.8; 2.0), skin involvement (HR-2.1; 2.6) and pN+ status (HR-2.4; 3.5). Bone involvement did not compromise survival in this surgically treated set of patients.

Conclusion: Age < 45 is newly identified as significantly compromising DFS and OS in Oral Cancer. Established factors of skin involvement and pN+ are confirmed as impacting DFS-OS. An apparent improvement in survival in Stage II Cancers is noted as consequent to adoption of AJCC 8th edition staging.

Level of evidence: 2 (OCEBM 2011-Inception Cohort Study for Prognosis) Laryngoscope, 131:2254-2261, 2021.

Keywords: Oral cancer; age; disease free survival; neck nodal metastasis; overall survival; skin involvement.

MeSH terms

Academic Medical Centers / statistics & numerical data
Adult
Aged
Aged, 80 and over
Chemoradiotherapy, Adjuvant
Disease-Free Survival
Female
Follow-Up Studies
Humans
India / epidemiology
Male
Middle Aged
Mouth / pathology
Mouth / surgery
Mouth Neoplasms / diagnosis
Mouth Neoplasms / mortality*
Mouth Neoplasms / therapy
Neoplasm Recurrence, Local / epidemiology*
Neoplasm Recurrence, Local / prevention & control
Neoplasm Staging
Oral Surgical Procedures / statistics & numerical data*
Prognosis
Retrospective Studies
Risk Factors
Squamous Cell Carcinoma of Head and Neck / diagnosis
Squamous Cell Carcinoma of Head and Neck / mortality*
Squamous Cell Carcinoma of Head and Neck / therapy
Tertiary Care Centers / statistics & numerical data
Young Adult