Prognostic determinants of locally advanced buccal mucosa cancer: Do we need to relook the current staging criteria?
| Autor: | Nisheena Raghavan, Vikram Kekatpure, Vidyabhushan Rangappa, Vivek Shetty, Venkatraman Bhat, Vishal Yadav, Moni Abraham Kuriakose, Narayana Subramaniam, Nirav P. Trivedi, Tinku Thomas, Naveen Hedne Chandrashekar, Trupti Kolur, Nivya George, Vijay Pillai |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Cancer Research medicine.medical_specialty Multivariate analysis medicine.medical_treatment Biopsy Gingiva Gastroenterology Disease-Free Survival 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Carcinoma Humans Prospective Studies Stage (cooking) 030223 otorhinolaryngology Aged Neoplasm Staging business.industry Squamous Cell Carcinoma of Head and Neck Patient Selection Mouth Mucosa Cancer Buccal administration Chemoradiotherapy Adjuvant Middle Aged medicine.disease Prognosis Magnetic Resonance Imaging stomatognathic diseases Cheek Oncology 030220 oncology & carcinogenesis Buccal Mucosa Squamous Cell Carcinoma Cohort Practice Guidelines as Topic Female Mouth Neoplasms Oral Surgery business Tomography X-Ray Computed Adjuvant Follow-Up Studies |
| Zdroj: | Oral oncology. 95 |
| ISSN: | 1879-0593 |
| Popis: | Current guidelines advocate non-surgical treatment for T4b buccal mucosa carcinoma with surgery preferred in other stages. We investigated oncologic outcomes of this cohort in comparison with T4a cohort, treated by similar multi-modality approach of primary surgery followed by adjuvant treatment and identified prognostic determinants of survival.Oncologic outcome of prospectively accrued 282 patients with cT4a and cT4b buccal mucosa squamous cell carcinoma were evaluated for overall survival (OS) and disease free survival (DFS) at 2 years of the whole cohort and for the subgroups of T4a and T4b patients. Multivariate Cox proportional hazards regression analysis was performed to identify prognostic determinants.Of 277 eligible patients treated and followed for a median period of 21 months, the OS was comparable between T4a and T4b as 64% vs 58%, (p = 0.354). The DFS between the two subgroups was 64% vs 61%, (p = 0.316). Although there was 47% pathologic down staging from the clinical stage, there was no significant difference in oncologic outcome between pT4a and pT4b (OS, 57% vs 58% for T4a and T4b, p = 0.687; DFS, 58% vs 60% for T4a and T4b, p = 0.776). On multivariate analysis, extra capsular spread (p = 0.042), lateral pterygoid muscle involvement (p = 0.035) and defaulting adjuvant treatment (p 0.001) were independent predictors of outcome for the T4b cohort when other factors were controlled.Primary surgery followed by adjuvant chemo-radiotherapy offers comparable results in selected T4b gingiva and buccal mucosal cancer, suggesting the need to relook the staging criteria for oral cavity cancer. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect