Open AccessOral Squamous Cell Carcinoma: Patterns of Recurrence and Predictors of Early Mortality. The Urgent Need for Biomarker
Author(s) -
G. Lakshminarayana
Publication year - 2018
Publication title -
journal of global oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.002
H-Index - 17
ISSN - 2378-9506
DOI - 10.1200/jgo.18.91400
Subject(s) - medicine , perineural invasion , metastasis , oncology , disease , radiation therapy , cohort , cancer
Background: The burden of oral cancer in the Indian subcontinent is high. It is compounded by the fact of its high mortality due to late presentation. Despite strict selection criteria for curative treatment a substantial proportion develop early relapse and death. This subset of patients have an exceptionally resistant disease, even though they present at a curable stage. They pose a unique challenge to the treating physician because of the sudden transition to palliative options. Aim: The objective of the current study is to analyze the patterns of relapse and predictors of early mortality in oral squamous cell carcinoma patients treated with curative intent. Methods: We performed a retrospective study in a homogenous cohort of 88 oral squamous cell carcinoma patients who underwent primary surgery with intent to cure. The demographic, staging, treatment, histopathology parameters (tumor differentiation, margins, depth of invasion, deep tissue infiltration, perineural invasion, lympho-vascular invasion, presence of lymph node metastasis, number of metastatic lymph nodes, extra nodal extension) and follow-up details were extracted from the existing database. We tabulated the results for patterns of relapse and predictors of early mortality. Results: 15 (17%) patients died of disease in our study. 11 (12.5%) patients died within 9 months of diagnosis. 7 patients had local and/regional relapse, 7 developed distant metastasis, 1 patients had dermal metastasis. Deep tissue infiltration ( P = .013) and presence of nodal metastasis ( P = .015) were significant for disease-related mortality on bivariate logistic regression. Conclusion: Deep tissue infiltration and presence of nodal metastasis predicted for disease-related early mortality. These parameters directly corresponds to staging, more specifically to pathologic stage, which are available only after completion of primary surgery. This underscores the need for reliable biomarkers to predict early disease related mortality, initially at the time of diagnosis.