Determination of Significant Prognostic Factors for Maxillary Gingival Squamous Cell Carcinoma in 90 Cases

Abstract

BackgroundMaxillary gingival squamous cell carcinoma (MGSCC) occurs rather infrequently, compared to tongue and mandibular gingival carcinomas, among the cancers of the oral cavity. Therefore, significant numbers of MGSCC cases have not been statistically analysed. The aim of this study is to clarify the prognostic factors for MGSCC. MethodsWe performed the statistical analysis of 90 MGSCC cases primarily treated in our department from 1999 to 2014. ConclusionsThe patients (male: 36, female: 54) were aged between 38 and 93 years, and the mean age was 68.7 years. The number of patients in each tumour stage according to the TNM classification was as follows: T1: 15 cases, T2: 32 cases, T3: 13 cases, and T4: 30 cases. Forty-two patients were treated only by surgery, 5 only by radiotherapy, 3 by preoperative radiotherapy and surgery, and 40 patients were treated by combination therapy with preoperative chemoradiotherapy and surgery. Neck dissections were performed in 40 cases including 29 cases (11 primary and 18 secondary cases) of histopathologically diagnosed lymph node metastases. Extranodal extension was found in 74.3% cases with metastatic lymph nodes. The 5-year overall survival rate was 81.9%. In univariate analysis, the site of occurrence, stage of tumour, lymph node metastasis, and treatment contributed to the 5-year survival rate. Multivariate analysis demonstrated that the site of occurrence (posterior region) was an independent prognostic factor. Seventeen deaths occurred due to the primary disease, while three deaths were caused by other diseases. ConclusionThe posterior region cancers, according to the classification based on site of occurrence, were independent predictors of poor 5-year overall survival rate.

Local recurrence and survival after treatment of oral squamous cell carcinoma of the maxilla: A systematic review and meta-analysis

“…An overview of all the included studies and their characteristics is presented in Table 1 [2,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. All 20 included studies were observational.…”

“…Nine different treatment modalities were reported: 748/1185 (63%) patients had surgery only, 277/1185 (23%) had surgery with postoperative radiotherapy, 51/1185 (4%) had surgery with postoperative (chemo)radiotherapy, 40/1185 (3%) had preoperative intra-arterial chemotherapy with radiotherapy and surgery, 10/1185 (0.8%) had preoperative intravenous chemotherapy with radiotherapy and surgery, 3/1185 (0.3%) had preoperative radiotherapy with surgery, 27/1185 (2%) had no surgery and chemoradiotherapy, 19/1185 (2%) had no surgery and radiotherapy only, and 10/1185 (0.8%) patients had palliative treatment. Primary radiotherapy or chemoradiotherapy was performed with curative intent in 28/46 (61%) patients [9,10,20], with palliative intent in 3/46 (7%) patients [9], while 3/46 (7%) patients refused surgery [20] and in 12/46 (26%) patients the reason was unspecified [9,25,26]. In any event, patients who had primary radiotherapy or chemoradiotherapy had significantly lower survival rates compared to patients with primary surgical treatment [9,10,20].…”

“…Another study used preoperative intra-arterial chemotherapy followed by surgery to treat 40 patients with T2-4 stage tumours and tumour involvement of the soft palate, pterygoid muscle, and pterygoid process [26].…”

“…Preoperative intra-arterial chemoradiotherapy was conducted with fluorouracil 100 -300 mg daily for 21 days via cannulation of the superficial femoral artery. Furthermore, 42 patients with T1-2 tumours located anteriorly were treated with surgery only [26].…”

“…In case of advanced disease, close/positive surgical margins (after reresection), cervical lymph node involvement, extracapsular spread, unfavourable histopathological features [13, 26, 2/27] and involvement of soft palate/pterygoid process/pterygoid muscles [26], either postoperative radiotherapy [13], postoperative (chemo)radiotherapy [2/27] or preoperative intra-arterial chemoradiotherapy [26] was reported.…”