Prognostic determinants of locally advanced buccal mucosa cancer: Do we need to relook the current staging criteria?

Pillai, Vijay; Yadav, Vishal; Kekatpure, Vikram D.; Trivedi, Nirav; Chandrashekar, Naveen Hedne; Shetty, Vivek; Rangappa, Vidyabhushan; Subramaniam, Narayana; Bhat, Venkatraman; Raghavan, Nisheena; Kolur, Trupti; George, Nivya; Thomas, Tinku; Kuriakose, Moni Abraham

doi:10.1016/j.oraloncology.2019.05.021

Cited by 34 publications

(28 citation statements)

References 19 publications

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“…Most researchers prefer surgical treatment for BMC at all stages, although the latest guidelines advocate non‐surgical treatment for T4b BMC (Bobdey et al., 2018; Pillai et al., 2019). The result of our study also showed that surgical treatment could significantly reduce the cancer‐specific risk of death in BMC patients, which is consistent with the clinical experience of most doctors.…”

Section: Discussionmentioning

confidence: 99%

A competing risk nomogram for predicting cancer‐specific death of patients with buccal mucosa cancer

et al. 2020

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Objectives Our aim was to develop and validate a competing risk nomogram to determine the probability of cancer‐specific death in buccal mucosa cancer (BMC) patients. Materials and Methods We examined the records of BMC patients in the Surveillance, Epidemiology, and End Results (SEER) Program and First Affiliated Hospital of Nanchang University (China). We adopted the cumulative incidence function and Fine–Gray proportional hazards model based on univariate and multivariate analyses by R‐software to identify the risk factors associated with cancer‐specific death. Subsequently, a nomogram was developed and validated to predict the 3‐ and 5‐year probability of cancer‐specific death. Results In 1,286 BMC patients identified from SEER database, cumulative incidences of cancer‐specific death after diagnosis were 33.4% and 35.5% for 3 and 5 years, respectively. In the training cohort (n = 902) from SEER database, the Fine–Gray model indicated that age, Tumor Node Metastasis (TNM) stages, grade, surgery, and histological type were independent risk factors associated with cancer‐specific death, based on which a prognostic nomogram was developed. In the internal validation cohort from SEER database (n = 384) and the external validation cohort from our medical center (n = 174), the nomogram was well calibrated and showed remarkable prediction performance. Conclusion The nomogram created herein may prove to be a good assistant tool for assessing the prognosis of BMC patients.

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Section: Discussionmentioning

confidence: 99%

A competing risk nomogram for predicting cancer‐specific death of patients with buccal mucosa cancer

et al. 2020

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“…4,5 Although these findings cannot be considered conclusive, studying independent cohorts of OTSCCs could eliminate the presence of an 'anatomical bias'. [6][7][8] Surgical resection of primary OTSCC is still considered to be the gold standard of treatment. 9 Unfortunately, OTSCC is characterised by a high rate of recurrence, which strongly decreases patient survival rates.…”

Section: Introductionmentioning

confidence: 99%

“…Some studies have shown that oral tongue squamous cell carcinoma (OTSCC) has different molecular features and clinical behaviour from those of OSCC from other subsites of the oral cavity 4,5 . Although these findings cannot be considered conclusive, studying independent cohorts of OTSCCs could eliminate the presence of an ‘anatomical bias’ 6–8 . Surgical resection of primary OTSCC is still considered to be the gold standard of treatment 9 .…”

Section: Introductionmentioning

confidence: 99%

Addition of the tumour–stroma ratio to the 8th edition American Joint Committee on Cancer staging system improves survival prediction for patients with oral tongue squamous cell carcinoma

et al. 2020

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Aims One of the objectives of current research is to customise the treatment of cancer patients. The achievement of this objective requires stratification of patients based on the most significant prognostic factors. The aims of this study were to evaluate the prognostic value of the tumour–stroma ratio (TSR), defined as the proportion of tumour cells relative to surrounding stroma, in patients with oral tongue squamous cell carcinoma (OTSCC), and to develop a prognostic nomogram based on the most significant clinicopathological features. Methods and results Clinicopathological data of 211 patients treated at ‘Ospedali Riuniti’ General Hospital (Ancona, Italy) for OTSCC were collected. One hundred and thirty‐nine patients were restaged according to the 8th edition American Joint Committee on Cancer (AJCC) staging system. Evaluation of the TSR was performed on haematoxylin and eosin‐stained slides, and correlation with survival outcomes was evaluated. In addition, with the aim of integrating the independent value of the TSR with the 8th edition AJCC staging system, a prognostic nomogram for OTSCC has been developed. OTSCC with a low TSR (i.e. a high proportion of stroma and a low proportion of tumour cells) was shown to have negative prognostic value in terms of disease‐specific survival, with a hazard ratio (HR) of 1.883 and a 95% confidence interval (CI) of 1.033–3.432 (P = 0.039), and overall survival (HR = 1.747, 95% CI 0.967–3.154; P = 0.044), independently of other histological and clinical parameters. For the cohort of 139 patients restaged according to the 8th edition AJCC staging system, variables correlating with a poor prognosis were: the TSR, perineural invasion, and sex. The nomogram built on these parameters showed good predictive capacity, outperforming the 8th edition AJCC staging system in stratifying disease‐specific survival in OTSCC patients. Conclusions Including the TSR in the predictive model could improve risk stratification of OTSCC patients and aid in making treatment decisions.

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“…Our study shows there was no statistically significant survival difference between negative (>/=0.5 cm) and close (<0.5 cm) margin (P value for OS = .750). Some contemporary literature 15,16 also showed that R0 resection even with a close surgical margin(<1 cm) may have comparable survival especially in post-NACT settings and in supra-notch tumors.…”

Section: Margin -Does It Matter?mentioning

confidence: 98%

“…In our study, surgically treated patients had improved disease control with a 3-year OS rate of 44.2%. We followed the concept of compartmental resection similar to Pillai et al 16 in all the operated cases.…”

Section: Upfront Operable T4b Osccmentioning

confidence: 99%

Survival Impact of Surgical Resection in Locally Advanced T4b Oral Squamous Cell Carcinoma

et al. 2021

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Objective/Hypothesis: With non-surgical treatment, T4b oral squamous cell carcinoma (OSCC) have an unacceptably poor prognosis. A subset of patients if selected wisely for surgery, can have significantly improved survival. The present study aims to explore the feasibility of radical resection and neoadjuvant chemotherapy (NACT) in the T4b OSCC and their impact on survival, along with the factors affecting it.Study Design: This is a retrospective analysis of 302 consecutive patients with T4b OSCC presented at our institute between July 2015 and January 2016.Methods: Three different treatment protocols were decided depending on the extent of the disease-upfront resection, NACT (followed by surgery or chemo/radiation depending on the response), or upfront non-surgical treatment (chemotherapy and/or radiotherapy).Results: Upfront surgery was done in 67 (22.19%) patients and 155 (51.32%) patients received NACT. The rest of the patients received upfront non-surgical treatment. The overall response rate of NACT was 23.23% and the resectability rate was 36.13%. The median OS for the whole population was 12 months (30 months for the surgical group and 9 months for the non-surgical group). There was no survival difference between supra versus infra-notch tumors (P value = .552) or post-NACT versus upfront surgery (P value = .932). Nodal involvement was the most important poor prognostic factor affecting both DFS (P = .006) and OS (P = .002).Conclusions: With proper patient selection after thorough clinico-radiological assessment, a subset of T4b OSCC can be operated with curative intention; either upfront or after downstaging with NACT, which ultimately translates into improved survival.

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Prognostic determinants of locally advanced buccal mucosa cancer: Do we need to relook the current staging criteria?

Cited by 34 publications

References 19 publications

A competing risk nomogram for predicting cancer‐specific death of patients with buccal mucosa cancer

A competing risk nomogram for predicting cancer‐specific death of patients with buccal mucosa cancer

Addition of the tumour–stroma ratio to the 8th edition American Joint Committee on Cancer staging system improves survival prediction for patients with oral tongue squamous cell carcinoma

Survival Impact of Surgical Resection in Locally Advanced T4b Oral Squamous Cell Carcinoma

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