Postoperative risk stratification in oral squamous cell carcinoma

Area of Science:

• Oncology
• Surgical Oncology
• Cancer Staging

Background:

• Accurate postoperative prognostic stratification is crucial for oral squamous cell carcinoma (OSCC) management.
• Current staging (Union for International Cancer Control TNM 8th edition) may not fully capture all prognostic factors influencing adjuvant radiotherapy decisions.
• The relative importance of prognostic factors can vary within different risk categories.

Purpose of the Study:

• To evaluate the utility of the Union for International Cancer Control TNM 8th edition staging rules for postoperative prognostic stratification in OSCC.
• To identify independent prognostic factors and clinically relevant risk categories for OSCC patients.
• To determine if a specific patient subgroup could benefit from adjuvant radiotherapy.

Main Methods:

• Retrospective analysis of 644 OSCC patients who underwent curative surgery (March 2006 - February 2017).
• Re-staging patients according to UICC TNM 8th edition criteria.
• Evaluation of clinical and pathological prognostic variables using regression analysis to estimate hazard ratios and identify independent factors.

Main Results:

• Identified an intermediate risk group of OSCC patients, including those with pN1 disease or pT3 disease based on depth of invasion (>10 mm).
• The significance of pathological prognostic factors varied depending on the overall risk category.
• Established clinically-relevant risk categories with minimal residual prognostic variables.

Conclusions:

• Postoperative prognostic stratification using UICC TNM 8th edition can refine patient selection for adjuvant radiotherapy in OSCC.
• A distinct intermediate risk group requires further investigation through clinical trials to assess the benefits of adjuvant radiotherapy.
• Individual prognostic factors should be interpreted within the context of the overall risk category for OSCC management.