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. 2025 Feb 2;17(2):e78395.
doi: 10.7759/cureus.78395. eCollection 2025 Feb.

Clinical Study on Postoperative Treatment for Patients at High Risk of Oral Squamous Cell Carcinoma Recurrence

Kei-Ichiro Miura  1 , Mitsunobu Otsuru  2 , Hiromasa Fukushima  1 , Keisuke Omori  1 , Tomofumi Naruse  1 , Masahiro Umeda  1 , Tomohiro Yamada  1
Affiliations

Clinical Study on Postoperative Treatment for Patients at High Risk of Oral Squamous Cell Carcinoma Recurrence

Kei-Ichiro Miura et al. Cureus. .

Abstract

Background: Surgery is the standard treatment for oral squamous cell carcinoma (OSCC), and concurrent chemoradiotherapy (CRT) is recommended in cases where extranodal extension (ENE) or positive margins are found histopathologically after surgery. However, the indications and efficacy of CRT remain controversial. In this study, we investigated the efficacy of postoperative treatment by examining risk factors for postoperative OSCC recurrence.

Methodology: We investigated the postoperative treatment and prognosis of 52 patients with OSCC with high-risk factors for recurrence (28 with ENE only, 17 with positive margins only, and seven with both). ENE was classified into minor ENE (ENEmi < 2 mm) and major ENE (ENEma ≥ 2 mm).

Results: The prognosis for ENEmi was good regardless of whether postoperative treatment was administered; however, the prognosis for ENEma was significantly poor. In the ENEma group, the prognosis of the patients who underwent radiotherapy (RT) or CRT was better than that of patients who did not undergo postoperative treatment, with no significant differences between the RT and CRT groups. In patients with positive margins, the prognosis was better in those who underwent additional resection than in those who underwent CRT.

Conclusions: Patients with ENEma have a poor prognosis and require additional treatment with RT or CRT. Re-resection may improve the prognosis in patients with positive margins.

Keywords: concurrent chemoradiotherapy; efficacy; oral squamous cell carcinoma; postoperative treatment; recurrence.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. The Clinical Research Ethics Committee of Nagasaki University Hospital issued approval 24021905. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Extranodal extension.
Green area: Metastatic lymph node. Purple area: Extranodal extension site. Dotted line: Hypothetical capsule surface. Double-headed arrow: Distance between the hypothetical capsule surface and the leading edge of extranodal invasive tumor cells. ENEmi was defined as tumor cell infiltration of less than 2 mm from the hypothetical capsule surface, while ENEma was defined as 2 mm or more. Image credit: Hiromasa Fukushima.
Figure 2
Figure 2. Kaplan-Meier survival curves for five-year overall survival (OS), five-year disease-specific survival (DSS), five-year loco-regional control (LRC), and five-year disease-free survival (DFS) according to postoperative treatment for ENE-only patients.
RT, radiation; CRT, chemoradiotherapy; ENE, extranodal extension
Figure 3
Figure 3. Kaplan-Meier survival curves for five-year OS, five-year DSS, five-year LRC, and five-year DFS according to the level of progression of ENE.
OS, overall survival; DSS, disease-specific survival; LRC, loco-regional control; DFS, disease-free survival; ENE, extranodal extension; ENEmi, ENE minor; ENEma, ENE major
Figure 4
Figure 4. Kaplan-Meier survival curves for five-year OS, five-year DSS, five-year LRC, and five-year DFS in the ENEma group.
OS, overall survival; DSS, disease-specific survival; LRC, loco-regional control; DFS, disease-free survival; ENE, extranodal extension; ENEma, ENE major; RT, radiation; CRT, chemoradiotherapy
Figure 5
Figure 5. Kaplan-Meier survival curves for five-year OS, five-year DSS, five-year LRC, and five-year DFS in the positive margins group.
OS, overall survival; DSS, disease-specific survival; LRC, loco-regional control; DFS, disease-free survival; CRT, chemoradiotherapy
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