OTOLARYNGOLOGY HEAD AND NECK

Factors predicting poor outcomes in T1N0 oral squamous cell carcinoma: indicators for treatment intensification

Corresponding Author

Tsu-Hui (Hubert) Low

Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia

Department of Otolaryngology Head and Neck, Victoria Hospital, London, Ontario, Canada

Correspondence

Dr Tsu-Hui (Hubert) Low, Fourth Avenue ENT Clinic, Suite 5, 35 Fourth Avenue, Eastwood, NSW 2122, Australia. Email: [email protected]

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Kan Gao,

Kan Gao

Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia

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Ruta Gupta,

Ruta Gupta

Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia

Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia

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Anthony Clifford,

Anthony Clifford

Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia

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Michael Elliott,

Michael Elliott

Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia

Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia

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Sydney Ch'ng,

Sydney Ch'ng

Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia

Institute of Academic Surgery at Royal Prince Alfred Hospital, The University of Sydney, Sydney, New South Wales, Australia

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Chris Milross,

Chris Milross

Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia

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Jonathan R. Clark,

Jonathan R. Clark

Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia

Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia

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Tsu-Hui (Hubert) Low,

Corresponding Author

Tsu-Hui (Hubert) Low

Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia

Department of Otolaryngology Head and Neck, Victoria Hospital, London, Ontario, Canada

Correspondence

Dr Tsu-Hui (Hubert) Low, Fourth Avenue ENT Clinic, Suite 5, 35 Fourth Avenue, Eastwood, NSW 2122, Australia. Email: [email protected]

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Kan Gao,

Kan Gao

Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia

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Ruta Gupta,

Ruta Gupta

Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia

Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia

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Anthony Clifford,

Anthony Clifford

Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia

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Michael Elliott,

Michael Elliott

Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia

Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia

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Sydney Ch'ng,

Sydney Ch'ng

Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia

Institute of Academic Surgery at Royal Prince Alfred Hospital, The University of Sydney, Sydney, New South Wales, Australia

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Chris Milross,

Chris Milross

Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia

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Jonathan R. Clark,

Jonathan R. Clark

Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia

Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia

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First published: 17 March 2016

https://doi.org/10.1111/ans.13504

Citations: 27

T.-H. Low FRACS; K. Gao BEng; R. Gupta FRCPA; A. Clifford FRACS; M. Elliott FRACS; S. Ch ng FRACS; C. Milross FRANZCR; J. R. Clark MBiostat, FRACS.

This study was presented at the International Federation of Head and Neck Oncologic Society on 27 July 2014, New York, NY.

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Abstract

Background

This study investigated the impact of adverse pathological features (APFs) amongst patients with T1N0 oral squamous cell carcinoma (OSCC) on both tumour control and survival. We aimed to investigate clinicopathological factors that would predict poor outcomes and determine a clinically relevant threshold for the recommendation of additional treatment.

Methods

Retrospective analysis of 121 patients from a single institution (1988–2013) who were treated with surgery only (wide local excision of the primary tumour with or without neck dissection). Only patients who are pT1cN0 or pT1pN0 were included. Patients who had received adjuvant radiotherapy were excluded from the study.

Results

APFs were associated with increased regional failure included tumour thickness (TT) ≥5 mm (P = 0.007), perineural invasion (PNI) (P = 0.003), infiltrative border (P = 0.030) and poor differentiation (P = 0.005). Poorly differentiated tumours were also associated with increased local failure (P = 0.03). Local control (LC), regional control (RC) and disease-specific survival (DSS) decreased with an increasing number of APFs (P = 0.009, P = <0.001 and P = 0.009, respectively). Patients with four or more APFs had significantly worse outcomes in LC (P < 0.001), RC (P < 0.001) and DSS (P < 0.001).

Conclusion

T1N0 OSCC exhibiting four or more APFs or demonstrating poor differentiation on histology had an increased risk of locoregional failure. The presence of PNI, infiltrative border and TT ≥5 mm are associated with increased regional failure. These factors may prompt escalation of treatment for patients with T1N0 OSCC.

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Volume86, Issue5

May 2016

Pages 366-371

Factors predicting poor outcomes in T1N0 oral squamous cell carcinoma: indicators for treatment intensification

Abstract

Background

Methods

Results

Conclusion

References

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Factors predicting poor outcomes in T1N0 oral squamous cell carcinoma: indicators for treatment intensification

Abstract

Background

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Conclusion

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