The role of clinical versus histopathological staging in patients with advanced oral squamous cell carcinoma treated with neoadjuvant radiochemotherapy followed by radical surgery

Abstract

Introduction: Several studies have questioned the prognostic accuracy of the TNM system for oral cancer since neither patient's comorbidity, specific tumor related factors nor multimodal treatment regimens such as preoperative radiochemotherapy (RCT) are incorporated. The present study was performed in order to evaluate the prognostic impact of cTNM and ypTNM in oral cancer patients treated with preoperative RCT and resection.

Methods: In this retrospective analysis a total of 139 patients (103 male, 36 female, average age 56.8 years) with oral squamous cell carcinoma (UICC II-IVb) were included. Treatment consisted of concomitant RCT with 39.6 Gy radiations and Carboplatin (cumulative dose 300 mg/m(2)) during the first week of radiation, as well as surgical tumor resection and neck dissection.

Results: During the mean follow up of 88.9 months 86 patients (61.9%) died. Locoregional recurrences occurred in 41 patients (29.5%). The 5 years overall survival rate was 45.5%. In univariate analysis margin status, ypT, ypN and ypUICC as well as complete pathological response revealed statistical significance on overall survival. In multivariate analysis ypT, ypN and margin status showed independent prognostic impact in our cohort. Neither cT nor cN provided statistical association with overall survival.

Conclusion: Results indicate that the clinical staging status of advanced oral cancer prior to preoperative RCT and resection should be interpreted with caution in terms of prognosis.