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Struckmeier AK, Buchbender M, Lutz R, Kesting M. Improved recurrence rates and progression-free survival in primarily surgically treated oral squamous cell carcinoma - results from a German tertiary medical center. Clin Oral Investig 2024; 28:262. [PMID: 38642146 PMCID: PMC11032275 DOI: 10.1007/s00784-024-05644-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/01/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVES This study aimed to explore survival and recurrence patterns in patients undergoing primarily surgical treatment for oral squamous cell carcinoma (OSCC) at a high-volume tertiary medical center in Germany. MATERIALS AND METHODS The study included 421 patients with primary OSCC who underwent radical tumor resection, neck dissection, and reconstruction with a free flap. Prognostic relevance of clinicopathological characteristics was assessed using Cox proportional-hazards models. Kaplan-Meier method estimated local recurrence-free survival, progression-free survival (PFS), and overall survival (OS), while the log-rank test compared survival outcomes between groups. RESULTS Recurrence manifested in 16.63% of the patients (70 patients), encompassing local recurrence in 54 patients (77.14%) and distant metastasis in 24 patients (34.28%). Neck recurrence occurred in only 1 patient (0.24%) on the contralateral side. The majority of recurrences occurred within the initial twelve months following primary tumor surgery (64.29%). Overall, the 5-year OS stood at 58.29%, while the 5-year PFS reached 72.53%. Patients with early recurrence within ≤ 12 months showed the least favorable prognosis (log-rank, all p < 0.001). CONCLUSIONS Our findings show a significant decrease in recurrence rates and enhanced PFS at a high-volume tertiary medical center in Germany compared to previous studies. Local recurrence was the primary form observed, with most recurrences happening within the initial twelve months post-surgery. Opting for treatment at a high-volume center and devising therapy plans in interdisciplinary tumor boards may not only enhance OS but also contribute to improved PFS. CLINICAL RELEVANCE These findings offer valuable insights for physicians regarding the post-treatment care of patients with OSCC. The results underscore the importance of frequent follow-up appointments, particularly during the initial year, and highlight the critical need for vigilance in monitoring for local recurrence.
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Affiliation(s)
- Ann-Kristin Struckmeier
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen- Nürnberg (FAU), Glückstraße 11, 91054, Erlangen, Germany.
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER- EMN), Erlangen, Germany.
| | - Mayte Buchbender
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen- Nürnberg (FAU), Glückstraße 11, 91054, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER- EMN), Erlangen, Germany
| | - Rainer Lutz
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen- Nürnberg (FAU), Glückstraße 11, 91054, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER- EMN), Erlangen, Germany
| | - Marco Kesting
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen- Nürnberg (FAU), Glückstraße 11, 91054, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER- EMN), Erlangen, Germany
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Nicholson OA, Van Lanschot CGF, van den Besselaar BN, Aaboubout Y, Iseli T, Hardillo JAU, Mast H, McDowell L, Koljenović S, Kranz S, Baatenburg de Jong RJ, Keereweer S, Wiesenfeld D. Management of the neck in T1 and T2 buccal squamous cell carcinoma. Int J Oral Maxillofac Surg 2024; 53:259-267. [PMID: 37640565 DOI: 10.1016/j.ijom.2023.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 08/31/2023]
Abstract
Buccal squamous cell carcinoma (SCC) appears to behave more aggressively than other oral subsites, in particular with regards to regional disease at presentation and regional recurrence. Adequate management of the neck is of the utmost importance but is still the subject of debate. An international multicentre retrospective review of 101 patients treated for T1-T2 buccal SCC was performed. Twenty-four were staged clinical node positive (cN+) and underwent therapeutic neck dissection, while 77 were node negative (cN0), with 32 undergoing elective neck dissection (END), with an occult nodal metastasis rate of 28.1%. Depth of invasion (DOI) < 4 mm was associated with a significantly lower rate of cervical nodal metastasis (87.5% versus 12.5%; P = 0.033). END demonstrated a non-significantly lower regional recurrence rate compared to observation (6.3% versus 8.9%, P = 0.670). Regional recurrence was more common in pN+ (24%) and undissected cases (8.9%) than in pN0 patients (0%) (P = 0.011) and was associated with DOI > 5 mm (P = 0.002). Regional recurrence resulted in a reduction in survival (24 versus 93 months, P < 0.001). In the pT2cN0 group, END improved survival (123 versus 26 months, P = 0.009). It is suggested that END be performed in cT2N0 buccal SCC, particularly for tumours with DOI > 4 mm.
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Affiliation(s)
- O A Nicholson
- Head and Neck Tumour Stream, Department of Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia.
| | - C G F Van Lanschot
- Department of Otorhinolaryngology Head and Neck Surgery, Erasmus Medical Centre Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - B N van den Besselaar
- Department of Otorhinolaryngology Head and Neck Surgery, Erasmus Medical Centre Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Y Aaboubout
- Department of Otorhinolaryngology Head and Neck Surgery, Erasmus Medical Centre Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Pathology, Erasmus Medical Centre Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - T Iseli
- Head and Neck Tumour Stream, Department of Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - J A U Hardillo
- Department of Otorhinolaryngology Head and Neck Surgery, Erasmus Medical Centre Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - H Mast
- Department of Oral and Maxillofacial Surgery, Erasmus Medical Centre Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - L McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - S Koljenović
- Department of Pathology, Erasmus Medical Centre Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Pathology, Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine, University of Antwerp, Antwerp, Belgium
| | - S Kranz
- Department of Pathology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - R J Baatenburg de Jong
- Department of Otorhinolaryngology Head and Neck Surgery, Erasmus Medical Centre Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - S Keereweer
- Department of Otorhinolaryngology Head and Neck Surgery, Erasmus Medical Centre Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - D Wiesenfeld
- Head and Neck Tumour Stream, Department of Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
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3
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Callander JK, Souza SS, Eltawil Y, El-Sayed IH, George JR, Ha P, Ryan WR, Xu MJ, Heaton CM. Prognostic risk factors of buccal squamous cell carcinoma: A case-control study. Head Neck 2024. [PMID: 38411290 DOI: 10.1002/hed.27705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 01/30/2024] [Accepted: 02/13/2024] [Indexed: 02/28/2024] Open
Abstract
OBJECTIVES To describe the clinicopathologic presentation of buccal squamous cell carcinoma and identify risks factors for recurrence and overall survival. METHODS This is a retrospective case-control study of patients with oral cavity squamous cell carcinoma (OCSCC) treated at a single tertiary care center between 2010 and 2022. All patients with buccal subsite OCSCC treated during this time frame were included and paired with a randomly selected age and gender matched patient with non-buccal OCSCC. Relevant data was collected via chart review. RESULTS Seventy-seven patients with buccal SCC were matched with 77 non-buccal OCSCC controls. The median follow-up time was 27 months (IQR 14-61). Median age was 67 years (IQR 57-75) and 53% of the cohort was female. Twenty (26%) buccal SCC patients experienced a recurrence versus 19 (25%) in the controls. Age ≥65-years-old increased odds of all-cause mortality in the buccal SCC group, but not in the control group. Perineural invasion and positive margins increased odds of recurrence in the buccal group only. Overall survival and progression-free survival did not differ between the groups, despite a greater number of T2 buccal tumors and T1 non-buccal tumors. CONCLUSIONS Buccal SCC presents at a higher T stage than other oral cavity SCC subsite and may exhibit variance in the pathologic risk factors that predict poor outcomes versus non-buccal OCSCC. Despite these relatively minor differences, however, oncologic outcomes between these groups were similar.
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Affiliation(s)
- Jacquelyn K Callander
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Spenser S Souza
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Yasmin Eltawil
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Ivan H El-Sayed
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, San Francisco, California, USA
| | - Jonathan R George
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, San Francisco, California, USA
| | - Patrick Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, San Francisco, California, USA
| | - William R Ryan
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, San Francisco, California, USA
| | - Mary Jue Xu
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, San Francisco, California, USA
| | - Chase M Heaton
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, San Francisco, California, USA
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Eskander A, Dziegielewski PT, Patel MR, Jethwa AR, Pai PS, Silver NL, Sajisevi M, Sanabria A, Doweck I, Khariwala SS, St John M. Oral Cavity Cancer Surgical and Nodal Management: A Review From the American Head and Neck Society. JAMA Otolaryngol Head Neck Surg 2024; 150:172-178. [PMID: 38153725 DOI: 10.1001/jamaoto.2023.4049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Importance Lymph node metastases from oral cavity cancers are seen frequently, and there is still inconsistency, and occasional controversies, regarding the surgical management of the neck in patients with oral cancer. This review is intended to offer a surgically focused discussion of the current recommendations regarding management of the neck, focusing on the indications and extent of dissection required in patients with oral cavity squamous cell carcinoma while balancing surgical risk and oncologic outcome. Observations The surgical management of the neck for oral cavity cancer has been robustly studied, as evidenced by substantial existing literature surrounding the topic. Prior published investigations have provided a sound foundation on which data-driven treatment algorithms can generally be recommended. Conclusions Existing literature suggests that patients with oral cavity cancer should be fully staged preoperatively, and most patients should receive a neck dissection even when clinically N0. Quality standards supported by the literature include separation of each level during specimen handling and lymph node yield of 18 or more nodes. Sentinel lymph node biopsy can be considered in select tumors and within a well-trained multidisciplinary team.
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Affiliation(s)
- Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Peter T Dziegielewski
- Department of Otolaryngology, University of Florida College of Medicine, Gainesville
| | - Mihir R Patel
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia
| | - Ashok R Jethwa
- Department of Otolaryngology-Head and Neck, University of Minnesota Medical School, Minneapolis
| | - Prathamesh S Pai
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | | - Mirabelle Sajisevi
- Department of Otolaryngology, The University of Vermont Medical Center, Burlington
| | - Alvaro Sanabria
- Department of Surgery, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Ilana Doweck
- Department of Otolaryngology, Head and Neck Surgery, Carmel Medical Center, Rappaport School of Medicine, Technion, Haifa, Israel
| | - Samir S Khariwala
- Department of Otolaryngology-Head and Neck, University of Minnesota Medical School, Minneapolis
| | - Maie St John
- Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, Los Angeles, California
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Iida Y, Okada S, Irifune Y, Goto S, Ishida K, Sato F, Yurikusa T, Asakura K, Tsuzuki A, Mukaigawa T. Clinicopathological Features of Buccal Squamous Cell Carcinoma with Focus on Patients Who Never Smoke and Never Drink. Int Arch Otorhinolaryngol 2023; 27:e551-e558. [PMID: 37876683 PMCID: PMC10593528 DOI: 10.1055/s-0042-1755433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/17/2022] [Indexed: 10/26/2023] Open
Abstract
Introduction Oral carcinoma has been reported at a substantial proportion in patients who never smoke and never drink. However, the proportion may vary by subsite and ethnicity. Objective We aimed to determine the clinicopathological features of buccal squamous cell carcinoma (SCC) in a Japanese population. Methods We retrospectively analyzed the records of patients diagnosed with buccal SCC at our institution from September 2002 to November 2015. We reviewed the gender, age, tumor status, treatment, smoking, alcohol drinking, multiple primary cancers, and prognosis of the patients. The overall and cause-specific survival rates were calculated, and the effects of clinicopathological variables were assessed by univariate analysis. Furthermore, the cause of death was evaluated. Results Among the 63 patients (men: 38; women: 25) included in the present study, 29 (46.0%) never smoked or drank. Women were almost 5 years older than men ( p = 0.014). The number of women in the group who never smoked or drank was disproportionately higher than that of those in the smoker or drinker groups ( p < 0.001). In total, 29 patients (46.0%) had 59 multiple primary cancers, including 26 oral cancers. Surgeries and radiotherapy were performed in 57 (90.5%) and 6 (9.5%) cases, respectively. The 5-year overall survival and disease-specific survival rates were 74.6 and 78.8%, respectively. Conclusion Our study confirms that buccal SCC may develop in older adult Japanese patients, especially in women who have never smoked or drank. These patients could be at risk for second primary malignancy.
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Affiliation(s)
- Yoshiyuki Iida
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Sunto-gun, Japan
- Division of Otorhinolaryngology, Iida ENT Clinic, Toride, Japan
| | - Shinichi Okada
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Sunto-gun, Japan
| | - Yuki Irifune
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Sunto-gun, Japan
| | - Seiya Goto
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Sunto-gun, Japan
| | - Kotaro Ishida
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Sunto-gun, Japan
| | - Fuyuki Sato
- Division of Diagnostic Pathology, Shizuoka Cancer Center, Sunto-gun, Japan
| | - Takashi Yurikusa
- Division of Dentistry and Oral Surgery, Shizuoka Cancer Center, Sunto-gun, Japan
| | - Koiku Asakura
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Sunto-gun, Japan
| | - Ayaka Tsuzuki
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Sunto-gun, Japan
| | - Takashi Mukaigawa
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Sunto-gun, Japan
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6
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Babu G, Ravikumar R, Rafi M, Sharafuddin Z, Shankar SA, George PS, Kainickal CT, Kunnambath R. Carcinoma buccal mucosa treated with definitive hypofractionated accelerated radiotherapy: a retrospective analysis of treatment outcomes. Singapore Med J 2023:384047. [PMID: 37675674 DOI: 10.4103/singaporemedj.smj-2021-282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Introduction Oral cancer is a major public health concern in India. Both conventional and altered fractionation radiotherapy schedules have been used in curative treatment of oral cancer. This study aimed to retrospectively evaluate the clinical profile and treatment outcomes of patients with carcinoma buccal mucosa who underwent treatment with definitive hypofractionated accelerated radiotherapy. Methods A total of 517 patients treated from January 2011 to December 2016 were eligible for the analysis. All patients were treated with definitive hypofractionated accelerated radiotherapy schedule of 5,250 cGy in 15 fractions over 3 weeks. Survival estimates were generated using the Kaplan-Meier method. Results At a median follow-up of 77.4 months, 473 (91.5%) patients attained complete remission with radiation therapy. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 69% and 80.5%, respectively. The 5-year OS for stage I, II, III and IVa tumours was 80.3%, 84.4%, 81.4% and 73.7%, respectively, and the DFS was 75.7%, 73.2%, 69.6% and 60.2%, respectively. Age >50 years was found to be a significant factor affecting DFS (P = 0.026) and OS (P = 0.048) in multivariate analysis. Fifty-three (10.3%) patients developed osteoradionecrosis of the mandible. Conclusion Excellent outcome could be achieved in less-aggressive, low-volume carcinoma of the buccal mucosa with radical accelerated hypofractionated radiotherapy. A radiotherapy schedule over a 3-week period is useful in high-volume centres.
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Affiliation(s)
- Geethu Babu
- Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Rejnish Ravikumar
- Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Malu Rafi
- Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Zuzaki Sharafuddin
- Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - S Arun Shankar
- Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Preethi Sara George
- Department of Cancer Epidemiology and Biostatistics, Regional Cancer Centre, Trivandrum, Kerala, India
| | | | - Ramadas Kunnambath
- Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
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7
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Adriaansens CMEM, Noorlag R, de Bree R, van Es RJJ. Treatment of buccal mucosal carcinomas: A survey amongst head and neck surgeons in the Netherlands. Laryngoscope Investig Otolaryngol 2023; 8:857-864. [PMID: 37621291 PMCID: PMC10446276 DOI: 10.1002/lio2.1081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 05/04/2023] [Accepted: 05/16/2023] [Indexed: 08/26/2023] Open
Abstract
Objective Currently, there is no up-to-date guideline for the treatment of buccal mucosal squamous cell carcinoma (BMSCC) in the Netherlands. A questionnaire was used to investigate the opinions of Dutch head and neck surgeons on BMSCC of the cheek treatment. Methods A questionnaire was sent to all 91 head and neck surgeons in the Netherlands. Their opinions on surgical tumor-free margins, through-and-through defects, and indications for local adjuvant therapy were questioned. Results The response rate was 51%. To prevent a through-and-through defect, 67% of the surgeons would accept a deep clinical (macroscopic) margin of ≤5 mm. The less adverse histological characteristics a tumor has, the less consensus there is amongst the surgeons for local adjuvant treatment in case of close margins. Conclusion There is no consensus amongst Dutch head and neck surgeons about the optimal treatment for BMSCC of the cheek. There are different opinions on acceptable resection margins, indications for a through-and-through defect, and indications for adjuvant treatment. BMSCC of the cheek treatment should be more uniform and less surgeon dependent. Level of evidence N/A.
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Affiliation(s)
| | - Rob Noorlag
- Department of Head and Neck Surgical OncologyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical OncologyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Robert J. J. van Es
- Department of Head and Neck Surgical OncologyUniversity Medical Center UtrechtUtrechtthe Netherlands
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8
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Verde-Sánchez L, Capote AL, Sanz-García A, Brabyn P, Rodríguez-Campo FJ, Naval Gías L. Prognostic Involvement of Lymph Node Density in Oral Squamous Cell Carcinoma. A New Predictive Model. J Oral Maxillofac Surg 2023; 81:358-369. [PMID: 36502856 DOI: 10.1016/j.joms.2022.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 10/17/2022] [Accepted: 11/20/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Lymph node density (LND) has been reported to be a significant predictor of survival in oral squamous cell carcinoma (OSCC). The aim of this study was to analyze LND as a prognostic factor in OSCC and create a predictive model that determines the probability of death in these patients. METHODS A retrospective cohort study was carried out with a cohort of patients who underwent cervical dissection and primary resection of OSCC between 1980 and 2020. The primary predictor variable in this study was LND, which is defined as the number of positive lymph nodes divided by the total number of lymph nodes removed. The cutoff values for prediction of disease-specific survival (DSS) were calculated by receiver operating characteristic curve analysis, which determined the best cutoff value was 0.07. Patients were divided into binary subgroups (low and high risk) using the best cutoff value of LND. The outcome variable was DSS, defined as the duration from the date of diagnosis to death due to OSCC and not due to other causes or secondary tumors. Other variables were type of neck dissection, postsurgical treatment, surgical margin, pathological T category stage, pathological N category (pN) stage, extranodal extension, perineural invasion, bone invasion, and presence of recurrence. A predictive model (score) was generated by selecting variables using a log-rank test and by using the Cox proportional-hazards regression (multivariate analysis). RESULTS The sample consisted of 368 patients, 252 (68.5%) male and 116 (31.5%) female patients, with a mean age of 60.3 years. According to the LND cutoff value, there were 289 patients with a low LND (≤0.07) and 79 with a high LND (>0.07). The univariate analysis showed LND as a significant predictor of DSS at 5 years (67.1% in LND ≤ 0.07 vs 32.9% in LND > 0.07; P < .001). The Cox multivariate analysis identified LND (hazard ratio [HR] = 27.2; 95% confidence interval [CI], 3.18-231; P = .002), recurrence (HR = 4.45; 95% CI, 2.3-8.4; P < .001), and type of treatment (HR = 0.52; 95% CI, 0.34-0.81; P < .001) as independent predictive factors for DSS. In the predictive model, the presence of recurrence was the most important factor with 8 points, whereas LND >0.07 contributed only 1 point; however, the 2 categories resulting from this limit were statistically significant. CONCLUSIONS Our study demonstrates that LND is an additional prognostic factor in patients with a pN+ disease. In addition, our predictive model could be useful in the therapeutic algorithm of OSCC patients, as it can predict the probability of death in these patients.
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Affiliation(s)
- Laura Verde-Sánchez
- Resident, Oral and Maxillofacial Surgery Department, University Hospital ''La Princesa", Madrid, Spain.
| | - Ana-Laura Capote
- Consultant, Oral and Maxillofacial Surgery Department, University Hospital ''La Princesa", Madrid, Spain
| | - Ancor Sanz-García
- Research Associate, Data Analysis Unit, University Hospital ''La Princesa", Madrid, Spain
| | - Philip Brabyn
- Consultant, Oral and Maxillofacial Surgery Department, University Hospital ''La Princesa", Madrid, Spain
| | | | - Luis Naval Gías
- Department Head, Oral and Maxillofacial Surgery Department, University Hospital ''La Princesa", Madrid, Spain
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Fan J, Fang Q, Yang Y, Cui M, Zhao M, Qi J, Luo R, Du W, Liu S, Sun Q. Role of Heterotypic Neutrophil-in-Tumor Structure in the Prognosis of Patients With Buccal Mucosa Squamous Cell Carcinoma. Front Oncol 2020; 10:541878. [PMID: 33178577 PMCID: PMC7593655 DOI: 10.3389/fonc.2020.541878] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022] Open
Abstract
Objective To analyze the role of frequency of heterotypic neutrophil-in-tumor structure (FNiT) in the prognosis of patients with buccal mucosa squamous cell carcinoma (BMSCC). Methods In vitro, we cocultured BMSCC cell line-H157 with neutrophils to form heterotypic neutrophil-in-tumor structures, which were then subject to fluorescence staining. Clinically, 145 patients were retrospectively enrolled. Associations between FNiT and clinicopathological variables including age, sex, smoking history, drinking history, betel nut chewing, tumor stage, node stage, metastasis, disease stage, lymphovascular invasion, extranodal extension, perineural invasion, and tumor grade were analyzed by chi-square test, and the main endpoints of interest were recurrence-free survival (RFS) and disease-specific survival (DSS) which were analyzed by the Kaplan-Meier method and Cox model. Results Fluorescent staining results of typical heterotypic neutrophil-in-tumor structure showed that well-differentiated H157 cells had a stronger ability to internalize more neutrophils than poorly-differentiated H157 cells, with the latter often internalizing only one neutrophil or nothing. The mean FNiT was 4.2‰, with a range from 2.3‰ to 7.8‰. A total of 80 patients relapsed and 84 patients died of the disease. The 5-year RFS and DSS rate was 42% and 42%, respectively. Patients with an FNiT≥4.2‰ had a significantly higher risk for locoregional recurrence and cancer-caused death than those with an FNiT<4.2‰ (p=0.001 and p<0.001, respectively). The FNiT alone was independently significant in predicting poor RFS, and the FNiT along with tumor grade was an independent predictor for DSS. Conclusion The FNiT as a novel predictor is significantly negatively associated with both the RFS and DSS of patients with BMSCC.
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Affiliation(s)
- Jie Fan
- Department of Head Neck and Thyroid Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China.,Laboratory of Cell Engineering, Institute of Biotechnology, Beijing, China
| | - Qigen Fang
- Department of Head Neck and Thyroid Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Yang Yang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Meng Cui
- Department of Head Neck and Thyroid Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Ming Zhao
- Department of Head Neck and Thyroid Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Jinxing Qi
- Department of Head Neck and Thyroid Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Ruihua Luo
- Department of Head Neck and Thyroid Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Wei Du
- Department of Head Neck and Thyroid Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China.,Department of Anatomy, Zhengzhou University, Zhengzhou, China
| | - Shanting Liu
- Department of Head Neck and Thyroid Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Qiang Sun
- Laboratory of Cell Engineering, Institute of Biotechnology, Beijing, China
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10
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Rath S, Gandhi AK, Rastogi M, Khurana R, Hadi R, Singh HB, Nanda SS, Azam M, Srivastava A, Bharati A, Mishra SP. Patterns of failure and clinical outcomes of post-operative buccal mucosa cancers treated with adjuvant ipsilateral radiotherapy. Radiat Oncol J 2020; 38:189-197. [PMID: 33012147 PMCID: PMC7533397 DOI: 10.3857/roj.2020.00458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/24/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose Adjuvant radiotherapy (RT) in buccal mucosa cancers is guided by histopathological factors. The decision to treat ipsilateral or bilateral draining lymph node is on physician discretion and guidelines do not have a defined indication regarding this. We aimed to analyze the failure patterns and survival in buccal mucosa cancers treated with adjuvant ipsilateral RT. Materials and Methods One hundred sixteen cases of post-operative buccal mucosa cancers—pT3 or more, node positive, close margins (1–5 mm), lymphovascular invasion positive, perineural invasion positive, depth of invasion >4 mm—treated with RT to primary and ipsilateral nodes from May 2013 to May 2019 were retrospectively analyzed. Patients were treated to a dose of 60–66 Gy (44 Gy in the first phase and a coned down boost of 16–22 Gy in the second phase) with three-dimensional conformal radiotherapy on a linear accelerator. Primary end point was to assess control rates and secondary end point was to evaluate the overall survival (OS) and disease-free survival (DFS) outcomes. Results Median age was 46 years with male; female ratio of 110:6. The edition of the American Joint Committee on Cancer stage distributions were I (3.4%), II (34.4%), III (24.1%), and IV (37.9%). At a median follow-up of 22 months, crude rates of local failure, regional failure, and contralateral neck failure were 9.4%, 10.3%, and 3.4%, respectively. The 2-year contralateral neck control rate was 94.9%. Pathological positive node portended poorer OS (86.6% vs. 68.6%; p = 0.015) and DFS (86.5% vs. 74.9%; p = 0.01). Conclusion Incidence of contralateral recurrence with ipsilateral irradiation in buccal mucosa cancers is low with descent survival outcomes, particularly in node negative cases.
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Affiliation(s)
- Satyajeet Rath
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ajeet K Gandhi
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Madhup Rastogi
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rohini Khurana
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rahat Hadi
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Harikesh B Singh
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sambit S Nanda
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mohammad Azam
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anoop Srivastava
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Avinav Bharati
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Surendra Prasad Mishra
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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11
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Marinelli LM, Chatzopoulos K, Marinelli JP, Chen TY, Collins AR, Sotiriou S, Raslan SW, Vêncio EF, Price DL, Garcia JJ, Janus JR. Clinicopathologic predictors of survival in buccal squamous cell carcinoma. J Oral Pathol Med 2020; 49:857-864. [PMID: 32449549 DOI: 10.1111/jop.13046] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Buccal squamous cell carcinoma (SCC) is a locoregionally aggressive malignancy, representing a small subset of oral cancers in North America. We investigated the prognostic value of several clinicopathologic factors in a cohort of patients diagnosed with buccal SCC. METHODS Between years 1992 and 2017, 52 patients were diagnosed with conventional buccal SCC. Archival surgical pathology material was retrospectively reviewed for reportable findings according to the latest reporting guidelines published by the College of American Pathologists. Clinical data were obtained through chart review. RESULTS The majority of patients were of older age, current or past smokers, and without specific gender predilection. Most presented at a clinically advanced stage and were treated with surgery alone, or surgery followed by adjuvant radiotherapy. The tumor recurred in about 40% of patients, and almost half of the patients died from the disease by the end of the follow-up period. The worst pattern of invasion (WPOI) was associated with greater depth of invasion (DOI) (P = .031) and perineural invasion (P < .001). In univariate analyses, older age (P = .004), positive nodal status (P = .047), lymphovascular invasion (P = .012), perineural invasion (P = .05), and WPOI-5 (P = .015) were adverse predictors of 5-year overall survival (OS). In multivariate analysis, older age (P = .011), WPOI-5 (P < .001), and perineural invasion (P = .001) remained statistically significant independent prognosticators of worse 5-year OS. CONCLUSIONS Older age, WPOI-5, and perineural invasion are significant prognosticators of worse OS. WPOI is associated with DOI, a finding which may have important implications for the pathogenesis and biologic behavior of the disease.
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Affiliation(s)
| | | | | | - Tiffany Y Chen
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Sotiris Sotiriou
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Eneida F Vêncio
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.,Department of Oral Medicine (Oral Pathology), Dental School, Federal University of Goiás, Goiânia, Brazil
| | - Daniel L Price
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Joaquin J Garcia
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jeffrey R Janus
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
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12
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Weckx A, Grochau KJ, Grandoch A, Backhaus T, Zöller JE, Kreppel M. Survival outcomes after surgical treatment of oral squamous cell carcinoma. Oral Dis 2020; 26:1432-1439. [PMID: 32428375 DOI: 10.1111/odi.13422] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/21/2020] [Accepted: 05/08/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To identify the clinicopathological parameters that influence survival in patients with oral squamous cell carcinoma, in order to allow for the development of individualized surveillance programmes and reduce the delay in diagnosis of recurrence. MATERIALS AND METHODS Retrospective chart review of 553 patients with a treatment-naïve primary oral squamous cell carcinoma, who underwent primarily curative intended surgery. Exclusion criteria were neoadjuvant radio(chemo)therapy, follow-up < 1 year, perioperative death, inoperable disease, synchronous multiple malignancies and inadequate information on clinicopathological parameters. RESULTS The clinicopathological factors that influence overall survival, disease-free survival and locoregional control were calculated. In the multivariate survival analysis, the occurrence of recurrence, presence of extracapsular spread, T- and N-classification were shown to be independent risk factors for overall survival. CONCLUSION The identification of these risk factors can lead to the development of individualized follow-up programmes based on risk stratification. This allows for the earliest possible diagnosis of relapse which is essential to offer the patient a realistic second treatment chance and to improve survival rates.
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Affiliation(s)
- Annelies Weckx
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Kathrin J Grochau
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Andrea Grandoch
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Tim Backhaus
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Joachim E Zöller
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Matthias Kreppel
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
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13
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Epidemiological Features and Management of Oral Cancer Patients: Experience from a Single Private Comprehensive Cancer Care Center in the State of Odisha. Indian J Otolaryngol Head Neck Surg 2019; 71:358-362. [PMID: 31741986 DOI: 10.1007/s12070-018-1309-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 03/17/2018] [Indexed: 10/17/2022] Open
Abstract
Oral cancer is the most common cancer in India. Challenges in the management of oral cancer patients in India include, delay in the presentation with high volume of advanced disease to be handled, affordability of patients and lack economical support especially in the non-governmental institutions and lack of awareness among patients and their relatives. Present study, a retrospective analysis of a prospectively maintained data, portrays the epidemiological features and management of patients with oral cancer presented to a private comprehensive cancer care hospital in the state of Odisha, India. A total of 1049 patients were considered for the analyses, managed between January 2014 and December 2016. Among 1049 patients, 20% (n, 215) were females and 80% (n, 834) were males. Mean age among the present cohort of patients was 50 years with age group 40-55 years being most common. All the patients underwent resection with curative intent and a 1 cm gross resection margins with or without bone and skin. Margin negative resection could be achieved in 82% of patients. Nodal involvement was seen in 36% of patients in the final histopathological assessment. Management of oral cancer patients is a major oncological and reconstructive challenge in India due to the advanced nature of disease at presentation. Inspite of socioeconomic constraints, these patients can be managed even in a private cancer centers with optimum outcomes. This is possible through coordinated team efforts.
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14
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Weckx A, Riekert M, Grandoch A, Schick V, Zöller JE, Kreppel M. Time to recurrence and patient survival in recurrent oral squamous cell carcinoma. Oral Oncol 2019; 94:8-13. [PMID: 31178216 DOI: 10.1016/j.oraloncology.2019.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/28/2019] [Accepted: 05/05/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Tumour relapse remains one of the major problems in managing oral squamous cell carcinoma (OSCC) with mortality rates of up to 92%. Early recurrences have a worse prognosis than late relapses. However, few has been written about the influence of clinicopathological parameters on the timing of recurrence and the patient survival. MATERIALS AND METHODS Retrospective chart review of 159 patients with an OSCC recurrent disease. Exclusion criteria were neoadjuvant chemoradiotherapy, follow-up <6 weeks, perioperative death, second primaries and inadequate information on clinicopathological parameters. Statistical analysis was performed using univariate and multivariate analysis. RESULTS A significant correlation was found in the χ2-analysis between the timing of recurrence and the margin status (p = 0.020), lymph node ratio (p = 0.030) and grading (p = 0.003) of the primary tumour. In the multivariate survival analysis, the timing of recurrence (p < 0.001), margin status of the primary tumour (p = 0.023), presence of extracapsular spread in the primary tumour (p = 0.003) and performance of a salvage treatment (p < 0.001) were shown to be independent risk factors for overall survival. CONCLUSION For patients with a recurrent OSCC, the time to recurrence, margin status, extracapsular spread and the performance of a salvage treatment are independent prognostic factors for overall survival. Furthermore, a significant association exists between the moment of recurrence and the lymph node ratio, the margin status and grading of the primary tumour. This knowledge can allow for the development of individualised surveillance programs and like this, an earlier diagnosis and better second treatment chance in the case of a recurrence.
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Affiliation(s)
- Annelies Weckx
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Kerpenerstraβe 62, 50937 Cologne, Germany.
| | - Maximilian Riekert
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Kerpenerstraβe 62, 50937 Cologne, Germany
| | - Andrea Grandoch
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Kerpenerstraβe 62, 50937 Cologne, Germany
| | - Volker Schick
- Department for Anesthesiology and Intensive Care, University of Cologne, Kerpenerstraβe 62, 50937 Cologne, Germany
| | - Joachim E Zöller
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Kerpenerstraβe 62, 50937 Cologne, Germany
| | - Matthias Kreppel
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Kerpenerstraβe 62, 50937 Cologne, Germany
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15
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Dillon JK, Villing AS, Jones RS, Futran ND, Brockhoff HC, Carlson ER, Schlieve T, Kademani D, Patel K, Claiborne ST, Dierks EJ, Ying YP, Ward BB. What Is the Role of Elective Neck Dissection in the Management of Patients With Buccal Squamous Cell Carcinoma and Clinically Negative Neck? J Oral Maxillofac Surg 2018; 77:641-647. [PMID: 30503978 DOI: 10.1016/j.joms.2018.10.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/06/2018] [Accepted: 10/27/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Buccal squamous cell carcinoma (BSCC) is rare in the United States. Given its location, few anatomic barriers to spread exist and it has been found to have a high locoregional recurrence rate. The role of elective neck dissection (END) in patients with clinically negative neck (N0) is not clear. This study aims to answer the following research question: Among patients with N0 BSCC, does END improve locoregional control rates, distant metastasis rates, and 2- and 5-year survival rates? MATERIALS AND METHODS A retrospective cohort study was conducted. The sample included patients who received a diagnosis of BSCC. The primary predictor variable was END status (yes or no). Five institutions participated between June 2001 and June 2011: University of Washington, University of Michigan, University of Tennessee, North Memorial Oral and Maxillofacial Surgery in Minnesota, and Head and Neck Surgical Associates (Portland, OR). The primary outcome variable was locoregional recurrence. Secondary outcome variables were distant metastasis and 2- and 5-year survival rates. Other variables collected were demographic characteristics, initial operation, adjuvant therapy, clinical and pathologic data, and staging. Kaplan-Meier and Cox proportional hazards statistics were computed. RESULTS The sample was composed of 98 patients with clinical N0 BSCC. The mean age was 66 years (range, 30-88 years), and 54% were men. Of the patients, 74 (76%) underwent END. The locoregional recurrence-free rate was 61% for END versus 38% for no END (P = .042). The distant metastasis rate was 4% for END versus 9% for no END. The 2- and 5-year disease-free survival rates were 91% and 75% (P = .042), respectively, for END and 85% and 63% (P = .019), respectively, for no END. CONCLUSIONS END had a therapeutic effect, as evidenced by a lower locoregional recurrence rate, lower distant metastasis rate, and improved 2- and 5-year survival rates.
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Affiliation(s)
- Jasjit K Dillon
- Clinical Associate Professor and Program Director, Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, WA.
| | - Akashdeep S Villing
- Formerly, Chief Resident, Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, WA. Currently, Private Practice, Surrey, British Columbia
| | - Richard S Jones
- Formerly, Chief Resident, Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, WA. Currently, Private Practice, Spokane, WA
| | - Neal D Futran
- Professor and Chair, Department of Otolaryngology, Head and Neck Surgery, University of Washington, Seattle, WA
| | - Hans C Brockhoff
- Formerly Oral and Maxillofaical Oncology and Microvascular Reconstruction Fellow, Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI. Currently, High Desert Oral and Facial Surgery, University Medical Center, El Paso, TX
| | - Eric R Carlson
- Professor and Chair, Department of Oral and Maxillofacial Surgery, University of Tennessee, Knoxville, TN
| | - Thomas Schlieve
- Formerly, Fellow, Department of Oral and Maxillofacial Surgery, University of Tennessee, Knoxville, TN. Currently, Assistant Professor and Program Director, Department of Oral and Maxillofacial Surgery, University of Texas Southwestern/Parkland Memorial Hospital, Dallas, TX
| | - Deepak Kademani
- Clinical Associate Professor, North Memorial Oral and Maxillofacial Surgery, Minneapolis, MN
| | - Ketan Patel
- Clinical Associate Professor, North Memorial Oral and Maxillofacial Surgery, Minneapolis, MN
| | - Scott T Claiborne
- Clinical Associate Professor, North Memorial Oral and Maxillofacial Surgery, Minneapolis, MN
| | - Eric J Dierks
- Affiliate Professor of Oral and Maxillofacial Surgery at Oregon Health and Science University Hospital, Portland, OR. Head and Neck Associates, Emmanuel Hospital, Portland, OR
| | - Yedeh P Ying
- Formerly, Fellow, Head and Neck Associates, Emanuel Hospital. Currently, Assistant Professor, Oral & Maxillofacial Surgery, University of Alabama, Birmingham, AL
| | - Brent B Ward
- Associate Professor and Chair, Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI
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16
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Xie L, Zhang Y, Huang W, Chen J, Yu J, Zhou X. In-Continuity Neck Dissection: Long-Term Oncological Outcomes in Squamous Cell Carcinoma of the Buccal Mucosa. J Oral Maxillofac Surg 2017; 76:1107-1116. [PMID: 29195080 DOI: 10.1016/j.joms.2017.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/27/2017] [Accepted: 10/31/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To introduce in-continuity neck dissection (ND) in squamous cell carcinoma of the buccal mucosa (BMSCC) and to determine its impact on the oncologic outcomes of these patients. MATERIALS AND METHODS A retrospective review of patients treated for BMSCC from 2006 through 2016 was performed. Kaplan-Meier analysis and log-rank test were used to evaluate local control, regional control (RC), distant metastasis (DM), and disease-specific survival (DSS) of in-continuity ND versus discontinuous ND in 220 previously untreated patients with BMSCC, followed by a multivariate Cox regression that included all relevant variables. RESULTS Fifty-three patients received discontinuous ND and 167 patients received in-continuity ND. The 2 groups were comparable. Univariate Kaplan-Meier analysis showed that 5-year DSS rates for the discontinuous ND and in-continuity ND groups were 38 and 62% (P = .023), respectively. The 5-year RC rate for the in-continuity ND group (81%) was significantly better (P = .004) than for the discontinuous ND group (54%). At Cox regression analysis, in-continuity ND meaningfully contributed to a higher RC rate and subsequently better DSS. CONCLUSION Compared with discontinuous ND, in-continuity ND predicted favorable oncologic outcomes in patients with BMSCC. In-continuity ND could be a practical approach in the surgical management of BMSCC.
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Affiliation(s)
- Li Xie
- Associate Professor, Department of Head and Neck Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.
| | - Yuanyuan Zhang
- Resident Doctor, Department of Sexually Transmitted Diseases, Hunan Center for Disease Prevention and Control, Changsha, China
| | - Wenxiao Huang
- Professor, Department of Head and Neck Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jie Chen
- Professor, Department of Head and Neck Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jianjun Yu
- Professor, Department of Head and Neck Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xiao Zhou
- Professor, Department of Head and Neck Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
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17
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Safi AF, Grandoch A, Nickenig HJ, Zöller JE, Kreppel M. Importance of lymph node ratio for locoregional recurrence of squamous cell carcinoma of the buccal mucosa. Head Neck 2017; 39:2488-2493. [DOI: 10.1002/hed.24922] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 04/23/2017] [Accepted: 07/14/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- Ali-Farid Safi
- Department of Oral and Craniomaxillofacial Plastic Surgery; University of Cologne; Cologne Germany
- Centre of Integrated Oncology (CIO); Cologne-Bonn Germany
| | - Andrea Grandoch
- Department of Oral and Craniomaxillofacial Plastic Surgery; University of Cologne; Cologne Germany
- Centre of Integrated Oncology (CIO); Cologne-Bonn Germany
| | - Hans-Joachim Nickenig
- Department of Oral and Craniomaxillofacial Plastic Surgery; University of Cologne; Cologne Germany
- Centre of Integrated Oncology (CIO); Cologne-Bonn Germany
| | - Joachim E. Zöller
- Department of Oral and Craniomaxillofacial Plastic Surgery; University of Cologne; Cologne Germany
- Centre of Integrated Oncology (CIO); Cologne-Bonn Germany
| | - Matthias Kreppel
- Department of Oral and Craniomaxillofacial Plastic Surgery; University of Cologne; Cologne Germany
- Centre of Integrated Oncology (CIO); Cologne-Bonn Germany
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18
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Safi AF, Kauke M, Grandoch A, Nickenig HJ, Drebber U, Zöller J, Kreppel M. The importance of log odds of positive lymph nodes for locoregional recurrence in oral squamous cell carcinoma. Oral Oncol 2017; 72:48-55. [DOI: 10.1016/j.oraloncology.2017.07.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/20/2017] [Accepted: 07/05/2017] [Indexed: 10/19/2022]
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19
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Sagheb K, Blatt S, Kraft IS, Zimmer S, Rahimi-Nedjat RK, Al-Nawas B, Walter C. Outcome and cervical metastatic spread of squamous cell cancer of the buccal mucosa, a retrospective analysis of the past 25 years. J Oral Pathol Med 2017; 46:460-464. [PMID: 27935122 DOI: 10.1111/jop.12537] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Because of the low proportion of squamous cell carcinomas (SCCs) of the buccal mucosa within the carcinomas of the oral cavity in the Western population, data concerning metastatic pattern are sparse. Therefore, this retrospective study is focusing on the occurrence of cervical metastases (CM) and the overall outcome of this tumor entity. MATERIALS AND METHODS From January 1988 to October 2013, 113 patients were treated in the Department of Oral and Maxillofacial Surgery, Mainz, for an oral SCC of the cheek. Metastatic pattern and clinical parameters that are possibly associated with an increased risk for CM as well as overall outcome were analyzed. RESULTS The average follow-up was 48 months (range: 1-248 months). A total of 55 (49%) patients were female and 58 (51%) male, with an average age of 65 ± 13 years (♀68 ± 14 years; ♂63 ± 11 years). In total, 55% of the patients either smoked and/or consumed alcohol. In total, 34% of the patients had a stage III or IV tumor, with overall 23% having CM at the time of diagnosis. During the follow-up, 50% (n = 56) of the patients developed a relapse after 12 months (median). Tumor size (P = 0.002*) and grading (P < 0.001*) are significantly associated with the occurrence of CM. Metastases (P = 0.008*) and advanced tumor size (P = 0.018) had an influence on the survival, whereas the relapse had no significant influence (P = 0.928). Five-year survival rate was 80%. CONCLUSIONS SCC of the buccal mucosa shows aggressive behavior with a considerably high proportion of relapse. Since overall outcome is significantly decreased by the cervical metastatic pattern, a selective, ipsilateral neck dissection for this patient group is recommended as the primary management.
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Affiliation(s)
- Keyvan Sagheb
- Department of Oral and Maxillofacial Surgery - Plastic Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sebastian Blatt
- Department of Oral and Maxillofacial Surgery - Plastic Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Ina Sophie Kraft
- Department of Oral and Maxillofacial Surgery - Plastic Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Stefanie Zimmer
- Department of Pathology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Roman-Kia Rahimi-Nedjat
- Department of Oral and Maxillofacial Surgery - Plastic Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery - Plastic Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Christian Walter
- Department of Oral and Maxillofacial Surgery - Plastic Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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20
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Niu LX, Feng Z, Li JN, Li CZ, Peng X, Guo CB. Prognostic Factors of Squamous Cell Carcinoma of the Buccal Mucosa: A Retrospective Study of 168 Cases in North China. J Oral Maxillofac Surg 2014; 72:2344-50. [DOI: 10.1016/j.joms.2014.05.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/21/2014] [Accepted: 05/21/2014] [Indexed: 11/16/2022]
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21
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Xu SS, Li D, Zhou Y, Sheng B, Zeng C, Zhong SX. Pathways involved in the spread of buccal carcinoma on contrast-enhanced multislice CT. Dentomaxillofac Radiol 2014; 44:20140111. [PMID: 25315441 DOI: 10.1259/dmfr.20140111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To explore how buccal carcinoma spread, using contrast-enhanced multislice CT (CEMSCT). METHODS We retrospectively analysed the extent of lesions in 56 patients with primary buccal squamous cell carcinoma (SCCA). Abnormal manifestations on CEMSCT at oral subsites and involved adjacent structures were documented and evaluated, which were compared with the results of surgery and histopathology. RESULTS Infiltration and spread to oral subsites and/or adjacent structures was confirmed in 33 patients (58.9%). The opening of the Stensen duct was the most commonly invaded oral subsite (72.7%); other sites included the gingivobuccal sulcus (60.6%), pterygomandibular raphe (54.5%), gingiva (24.2%), retromolar trigone (24.2%), orbicularis oris (18.2%) and the floor of mouth (15.2%). Of the involved adjacent structures, the buccal space was the most common site of spread (69.7%), followed by the masticatory muscles and spaces (57.6%), bone (54.5%), skin and subcutaneous fat (39.4%), pharynx (30.3%), investing fascia (15.2%) and the base of the skull (6.1%). CEMSCT manifestations of the involvement in buccal SCCAs had correlations with pathological findings (p < 0.05). The sensitivities, specificities and accuracies of two radiologists' evaluation on buccal carcinoma involvement were 50.00%, 23.21% and 73.21%; and 51.79%, 32.14% and 83.93%, respectively. CONCLUSIONS Buccal SCCAs could superficially and deeply spread to multiple oral subsites and/or adjacent structures. CEMSCT could delineate their spread pathways and extents.
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Affiliation(s)
- S-S Xu
- 1 Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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22
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Huang SF, Tung-Chieh Chang J, Liao CT, Kang CJ, Lin CY, Fan KH, Wang HM, Chen IH. The role of elective neck dissection in early stage buccal cancer. Laryngoscope 2014; 125:128-33. [DOI: 10.1002/lary.24840] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 06/04/2014] [Accepted: 06/23/2014] [Indexed: 02/06/2023]
Affiliation(s)
- Shiang-Fu Huang
- Department of Otolaryngology; Head and Neck Surgery; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
- Head and Neck Oncology Group; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
- Head and Neck Oncology Group; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
| | - Chun-Ta Liao
- Department of Otolaryngology; Head and Neck Surgery; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
- Head and Neck Oncology Group; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
| | - Chung-Jan Kang
- Department of Otolaryngology; Head and Neck Surgery; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
- Head and Neck Oncology Group; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
- Head and Neck Oncology Group; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
| | - Kang-Hsing Fan
- Department of Radiation Oncology; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
- Head and Neck Oncology Group; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
| | - Hung-Ming Wang
- Department of Internal Medicine; Division of Hematology/Oncology; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
- Head and Neck Oncology Group; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
| | - I-How Chen
- Department of Otolaryngology; Head and Neck Surgery; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
- Head and Neck Oncology Group; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
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23
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Camilon PR, Stokes WA, Fuller CW, Nguyen SA, Lentsch EJ. Does buccal cancer have worse prognosis than other oral cavity cancers? Laryngoscope 2014; 124:1386-91. [DOI: 10.1002/lary.24496] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 10/17/2013] [Accepted: 10/25/2013] [Indexed: 11/07/2022]
Affiliation(s)
- P. Ryan Camilon
- Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina U.S.A
| | - William A. Stokes
- College of Medicine; Medical University of South Carolina; Charleston South Carolina U.S.A
| | - Colin W. Fuller
- Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina U.S.A
| | - Shaun A. Nguyen
- Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina U.S.A
| | - Eric J. Lentsch
- Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina U.S.A
- Hollings Cancer Center; Medical University of South Carolina; Charleston South Carolina U.S.A
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24
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Squamous cell carcinoma of the buccal mucosa: Analysis of clinical presentation, outcome and prognostic factors. Mol Clin Oncol 2013; 1:531-534. [PMID: 24649206 DOI: 10.3892/mco.2013.86] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 02/27/2013] [Indexed: 11/05/2022] Open
Abstract
Squamous cell carcinoma (SCC) of the buccal mucosa is a common malignancy in Southeast Asia. The purpose of this study was to present our clinical experience with buccal SCC over a period of 7 years and to analyze the factors associated with surgical outcome. We conducted a retrospective review on 67 buccal SCC patients (between September, 2005 and May, 2011) with tumors restricted to or originating from the buccal mucosa. In a univariate model, nodal stage, degree of tumor differentiation and composite resection were associated with recurrence, while in a multivariate model, the degree of differentiation was the only factor affecting locoregional control. In a survival analysis, recurrence, nodal stage and degree of differentiation were considered as significant factors. Buccal SCC is an aggressive malignant tumor and the degree of differentiation is the most significant factor affecting prognosis and survival. An adequate systemic treatment is required in the case of poorly differentiated tumors. Neck dissection (ND) exerts a positive effect on the locoregional control of buccal SCC staged as cT1-2N0. In the case of identification of positive lymph nodes during surgery, postoperative radiation is recommended in order to improve locoregional control.
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25
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Fang QG, Li ZN, Zhang X, Liu FY, Xu ZF, Sun CF. Clinical reliability of radial forearm free flap in repair of buccal defects. World J Surg Oncol 2013; 11:26. [PMID: 23363472 PMCID: PMC3598887 DOI: 10.1186/1477-7819-11-26] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 01/13/2013] [Indexed: 11/11/2022] Open
Abstract
Background The ideal method for buccal defects should provide good outcome of both function and appearance; our goal is to highlight the reliability of radial forearm flap in buccal reconstruction. Methods A retrospective study was conducted. From 2005 to 2012, 20 radial forearm flaps were used to repair the defects. We analyzed the superiority and reliability of the flap; in addition, we reviewed some related literature and made a comparison between radial forearm flap and platysma flap. Results All radial forearm flaps totally survived, but two flaps suffered venous obstruction, hematoma, respectively. Radial forearm flap preserved the original interincisal distance well. In our follow-up, all patients had sufficient mouth-opening width (mean: 4.3 cm). Conclusion Radial forearm flap is a reliable method for buccal defect reconstruction.
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Affiliation(s)
- Qi-Gen Fang
- Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, No, 117, Nanjing North Street, Heping District, 110002, Shenyang, Liaoning, People's Republic of China
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