Does Operable Stage IV Gingivobuccal Cancers Need Further Prognostic Subgrouping?

Area of Science:

• Oncology
• Head and Neck Cancer Research
• Cancer Staging and Prognosis

Background:

• Operable stage IV gingivobuccal complex cancer is currently classified into Stage IVA and IVB.
• Stage IVA encompasses diverse patient subgroups with varying prognoses, particularly those with advanced nodal status.
• Current staging may not adequately differentiate prognoses within Stage IVA, necessitating refined subgrouping.

Purpose of the Study:

• To assess the prognostic value of nodal status in operable stage IV gingivobuccal complex cancer.
• To evaluate the potential for subgrouping Stage IVA patients based on nodal status for improved prognostication.
• To analyze survival outcomes across different T and N stage combinations.

Main Methods:

• Prospective observational study conducted at a tertiary care center from July 2017 to June 2020.
• 113 patients with operable gingivobuccal complex stage IVA cancer were enrolled.
• Survival outcomes were analyzed using Kaplan-Meier, univariate, and multivariate analyses with a median follow-up of 26 months.

Main Results:

• Disease-free survival (DFS) varied significantly: 74% (Group I: T4aN0), 55% (Group II: T4aN1-2), 26% (Group III: T1-3N2), and 32.2% (Group IV: TanyN3).
• Patients with T4N3 disease (Group IV) had a DFS of only 15%.
• Groups III and IV exhibited the worst DFS and Overall Survival (OS) (HR-3.7, 3.3 and 3.3, 3.8 respectively, p=0.001).

Conclusions:

• Nodal status is the most critical prognostic factor influencing DFS and OS in this patient cohort.
• Patients with smaller primary tumors but advanced nodal disease have poorer outcomes compared to those with advanced primary tumors and node-negative disease.
• Subgrouping Stage IVA gingivobuccal complex cancer patients based on nodal status is essential for precise prognostication and tailored treatment strategies.