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Incidence and Outcomes of Patients With Oral Cavity Squamous Cell Carcinoma and Fourth Primary Tumors

View Article: PubMed Central - PubMed

ABSTRACT

The aim of this study was to explore the incidence and outcomes of patients with oral cavity squamous cell carcinoma (OSCC) and fourth primary tumors (PTs) in a betel-chewing endemic area.

We retrospectively examined the records of 1836 OSCC patients who underwent radical tumor resection between 1996 and 2014. The outcome measures included the incidence and number of multiple PTs, the main risk factors, and their associations with overall survival (OS).

Of the 1836 patients, 1400 (76.3%) had a single PT, 344 (18.7%) a second PT, 67 (3.6%) a third PT, and 25 (1.4%) a fourth PT. Univariate analyses (log-rank test) identified the following factors as significantly associated with a fourth PT: simultaneous first and second PTs, betel quid chewing, buccal subsite, and pT3–4 status. After allowance for the potential confounding effect of other risk factors, all of these factors retained their independent prognostic significance in stepwise multivariate analyses, the only exception being betel chewing. The incidences of second, third, and fourth PTs at 5 and 10 years were 20.2%/34.6%, 4.0%/8.6%, and 1.0%/2.3%, respectively. The 5 and 10-year OS rates (calculated from the diagnosis of each PTs) for patients with a single, second, third, and fourth PTs were 68%/61%, 43%/37%, 45%/39%%, and 30%/30%, respectively (P < 0.0001). Among patients with a fourth PT, those who underwent radical surgery showed a significantly higher 3-year OS than those who did not (57% vs 13%; P = 0.0442).

Fourth PTs are rarely observed in OSCC patients in a betel quid-chewing endemic area. Long-term survival rates of patients treated with radical surgery seems acceptable, being 4-fold higher than their counterparts.

No MeSH data available.


Related in: MedlinePlus

Postoperative images (from left to right: from the oral cavity to the oropharynx) of a representative OSCC patient who underwent 3 free flap reconstructions after removal of 4 primary malignancies (squamous cell carcinoma of the central tongue followed by squamous carcinomas of the retromolar trigone, hard palate, and upper gum). OSCC = oral cavity squamous cell carcinoma.
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Figure 3: Postoperative images (from left to right: from the oral cavity to the oropharynx) of a representative OSCC patient who underwent 3 free flap reconstructions after removal of 4 primary malignancies (squamous cell carcinoma of the central tongue followed by squamous carcinomas of the retromolar trigone, hard palate, and upper gum). OSCC = oral cavity squamous cell carcinoma.

Mentions: Surgery remains the mainstay of treatment for OSCC (both for the index malignancy and subsequent multiple PTs).42 Because multiple PTs are expected to portend a poor prognosis, a more aggressive surgical approach is warranted.43 In line with our previously described approach for second PTs,27 fourth and fifth PTs arising from the oral cavity/soft palate were treated as the first OSCC. In general, radical surgery aimed at obtaining adequate safety margins was the approach of choice for all operable patients (according to their performance status). Among the subgroup of patients who developed a fourth PT, subjects who underwent radical surgery showed a significantly higher 3-year OS than those who did not (57% vs 13%, respectively; P = 0.0442). Obviously, the surgical strategy needs to be carefully weighted in each patient against potential cosmetic and functional complications. For example, some patients in the current study underwent a total or subtotal replacement of the normal oral mucosa by multiple tissue flaps (used for reconstruction) after removal of each newly diagnosed PT. Figure 3 shows the current status of a patient (#14; Table 3) who underwent surgery from a fourth primary malignancy and 3 consecutive free flap reconstructions (after removal of tumors located in the central tongue, left retromolar trigone, hard palate, and right upper gum). In this specific case, the anterior part of the upper gum was the only portion of the native oral cavity that was actually preserved. Serial demolitions and reconstructions may significantly affect the patient's communication and swallowing abilities, ultimately requiring, in some cases, the insertion of a nasogastric tube or a permanent tracheostomy.


Incidence and Outcomes of Patients With Oral Cavity Squamous Cell Carcinoma and Fourth Primary Tumors
Postoperative images (from left to right: from the oral cavity to the oropharynx) of a representative OSCC patient who underwent 3 free flap reconstructions after removal of 4 primary malignancies (squamous cell carcinoma of the central tongue followed by squamous carcinomas of the retromolar trigone, hard palate, and upper gum). OSCC = oral cavity squamous cell carcinoma.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998365&req=5

Figure 3: Postoperative images (from left to right: from the oral cavity to the oropharynx) of a representative OSCC patient who underwent 3 free flap reconstructions after removal of 4 primary malignancies (squamous cell carcinoma of the central tongue followed by squamous carcinomas of the retromolar trigone, hard palate, and upper gum). OSCC = oral cavity squamous cell carcinoma.
Mentions: Surgery remains the mainstay of treatment for OSCC (both for the index malignancy and subsequent multiple PTs).42 Because multiple PTs are expected to portend a poor prognosis, a more aggressive surgical approach is warranted.43 In line with our previously described approach for second PTs,27 fourth and fifth PTs arising from the oral cavity/soft palate were treated as the first OSCC. In general, radical surgery aimed at obtaining adequate safety margins was the approach of choice for all operable patients (according to their performance status). Among the subgroup of patients who developed a fourth PT, subjects who underwent radical surgery showed a significantly higher 3-year OS than those who did not (57% vs 13%, respectively; P = 0.0442). Obviously, the surgical strategy needs to be carefully weighted in each patient against potential cosmetic and functional complications. For example, some patients in the current study underwent a total or subtotal replacement of the normal oral mucosa by multiple tissue flaps (used for reconstruction) after removal of each newly diagnosed PT. Figure 3 shows the current status of a patient (#14; Table 3) who underwent surgery from a fourth primary malignancy and 3 consecutive free flap reconstructions (after removal of tumors located in the central tongue, left retromolar trigone, hard palate, and right upper gum). In this specific case, the anterior part of the upper gum was the only portion of the native oral cavity that was actually preserved. Serial demolitions and reconstructions may significantly affect the patient's communication and swallowing abilities, ultimately requiring, in some cases, the insertion of a nasogastric tube or a permanent tracheostomy.

View Article: PubMed Central - PubMed

ABSTRACT

The aim of this study was to explore the incidence and outcomes of patients with oral cavity squamous cell carcinoma (OSCC) and fourth primary tumors (PTs) in a betel-chewing endemic area.

We retrospectively examined the records of 1836 OSCC patients who underwent radical tumor resection between 1996 and 2014. The outcome measures included the incidence and number of multiple PTs, the main risk factors, and their associations with overall survival (OS).

Of the 1836 patients, 1400 (76.3%) had a single PT, 344 (18.7%) a second PT, 67 (3.6%) a third PT, and 25 (1.4%) a fourth PT. Univariate analyses (log-rank test) identified the following factors as significantly associated with a fourth PT: simultaneous first and second PTs, betel quid chewing, buccal subsite, and pT3–4 status. After allowance for the potential confounding effect of other risk factors, all of these factors retained their independent prognostic significance in stepwise multivariate analyses, the only exception being betel chewing. The incidences of second, third, and fourth PTs at 5 and 10 years were 20.2%/34.6%, 4.0%/8.6%, and 1.0%/2.3%, respectively. The 5 and 10-year OS rates (calculated from the diagnosis of each PTs) for patients with a single, second, third, and fourth PTs were 68%/61%, 43%/37%, 45%/39%%, and 30%/30%, respectively (P < 0.0001). Among patients with a fourth PT, those who underwent radical surgery showed a significantly higher 3-year OS than those who did not (57% vs 13%; P = 0.0442).

Fourth PTs are rarely observed in OSCC patients in a betel quid-chewing endemic area. Long-term survival rates of patients treated with radical surgery seems acceptable, being 4-fold higher than their counterparts.

No MeSH data available.


Related in: MedlinePlus