Survival prognostic factors for lateral bucco-pharyngeal junction squamous cell carcinoma

Squamous cell carcinomas (SCC) localized at the lateral buccopharyngeal junction are frequent occurrences in our experience. This anatomical site gives the tumor ample space to spread in different directions, making tumor management all the more difficult. We focused our study on this localization to underline their specificities and evaluate our practices. In the Department of Head and Neck Oncology at the Centre Oscar Lambret, 57 patients with lateral bucco-pharyngeal junction SCC were treated from 1995 to 2000. Epidemiological data were extracted from the medical chart. Description of the tumor was based on clinical and imaging data. Treatment modalities frequently combined surgery, radiotherapy and chemotherapy. Protocol was adapted with the health status and the aggressiveness of the disease. Follow-up and survival rates are outlined below. Fifty men and seven women with a mean age of 57 years constitute the patient population. Forty-nine out of 57 presented a history of smoking, and 44 out of 46 presented a history of alcoholism. Patient overall clinical status, social and family background were also discussed. Thirty-one of fifty-seven tumors were categorized as T1 or T2. Forty-five out of fifty-seven presented limited lymph-node involvement. Tumor extension, growth pathology and degree of differentiation were described. Twenty-eight out of fifty-seven had undergone primary surgery. Primary radiotherapy with or without chemotherapy was delivered to the others. The modality of the different treatments and their results were specified. The 3-year disease-free survival rate was 52.7% and the 3-year overall survival rate was 48.2%. The mean survival rate was 3 years. Univariate analysis was performed on all occasions. Gender (P=0.008), surgery first versus non-surgical treatment first (P=0.03), spread beyond the midline (P=0.03), and small tumors T1 T2 versus T3 T4 (P=0.003) were predictive factors of overall survival. A Multivariate analysis showed that the type of treatment (surgery first versus no primary surgery P=0.006), and the T (T1, T2 versus T3, T4 P=0.005) were the two predictive factors of the overall survival. Because of the small size of the population studied, the retrospective nature of the study and the scarcity of the publications on the subject, results must be carefully interpreted. For example, surgery must be proposed whenever deemed possible. It is in an independent factor in our series. All the statuses linked to the population type, tumor extension and tumor differentiation are also discussed.