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. 2017 Jul 1;143(7):685-690.
doi: 10.1001/jamaoto.2017.0001.

Estimating Survival After Salvage Surgery for Recurrent Oral Cavity Cancer

Samantha Tam  1 , Rakhna Araslanova  1 , Tsu-Hui Hubert Low  2 , Andrew Warner  3 , John Yoo  4 , Kevin Fung  4 , S Danielle MacNeil  4 , David A Palma  5 , Anthony C Nichols  6
Affiliations

Estimating Survival After Salvage Surgery for Recurrent Oral Cavity Cancer

Samantha Tam et al. JAMA Otolaryngol Head Neck Surg. .

Abstract

Importance: Locoregional recurrence of oral cavity squamous cell carcinoma (OCSCC) continues to be a life-threatening and difficult clinical situation. Salvage surgery can result in significant morbidities, and survival following recurrence is poor.

Objective: To outline prognostic factors influencing overall survival (OS) following salvage surgery for OCSCC to guide management of treatment for patients with locoregionally recurrent disease.

Design, setting, and participants: The medical records of 293 patients presenting to the London Health Sciences Center with locoregionally recurrent OCSCC between October 5, 1999, and May 2, 2011, were retrospectively reviewed. The primary outcome was OS from salvage treatment to last follow-up or death. Univariate analyses were carried out using the Cox proportional hazards regression model. A recursive partitioning analysis was used to create risk groups based on prognosis. Analysis was conducted from December 8, 2015, to February 26, 2016.

Results: Of the 293 patients evaluated, 59 (20%) had recurrence identified after their initial OCSCC treatment; 39 (66%) were men, and the mean (SD) age at diagnosis was 62.2 (11.8) years. Thirty-nine (66%) of these patients underwent salvage surgery for locoregional recurrence with curative intent. Five-year OS from the time of salvage surgery was 43%. Recursive partitioning analysis identified 3 risk groups: (1) high risk (patients who received adjuvant chemoradiotherapy or radiotherapy after initial surgery) with 5-year OS rate of 10% (hazard ratio [HR], 9.41; 95% CI, 2.68-33.04), (2) intermediate risk (previous surgery alone, age ≥62 years) with a 5-year OS rate of 39% (HR, 2.95; 95% CI, 0.86-10.09), and (3) low risk (previous surgery alone, age <62 years) with 5-year OS rate of 74%.

Conclusions and relevance: This recursive partitioning analysis identified 3 prognostic groups in patients undergoing salvage surgery for recurrent OCSCC. The marked differences in survival between these groups should be taken into consideration when counselling and managing treatment for patients with locoregionally recurrent disease.

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Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Figures

Figure 1.
Figure 1.. Overall Survival in Patients Undergoing and Not Undergoing Salvage Surgery
Overall survival in patients with recurrent oral cavity cancer undergoing salvage surgery compared with those not undergoing salvage surgery.
Figure 2.
Figure 2.. Recursive Partitioning Analysis of Patients Undergoing Curative Intent Salvage Surgery
CRT indicates chemoradiotherapy; OCSCC, oral cavity squamous cell carcinoma; OS, overall survival; and RT, radiotherapy.
Figure 3.
Figure 3.. Patients Undergoing Curative Intent Salvage Surgery Using Recursive Partitioning Analysis End Points
CRT indicates chemoradiotherapy; RT, radiotherapy.
See this image and copyright information in PMC

Comment in

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