Survival Outcomes in Young Nonsmoking-Nondrinking Individuals With Oral Cavity Squamous Cell Carcinoma

To determine the impact of age and presence of traditional risk factors (smoking and drinking) on survival outcomes in a large cohort of patients with oral cavity squamous cell carcinoma (OCSCC).

This was a single-center, retrospective review from 2012 to 2019. Patients were divided by age (≤ 40 vs. > 40 years old) and whether they had significant tobacco and/or alcohol use history. Univariate and multivariate analyses were conducted to compare overall and disease-specific survival between the four groups.

There were 630 patients, and median follow-up was 52.5 months. Young, nonsmoker-nondrinker (NSND) patients (N = 17) were more likely to be women with higher BMI, fewer medical comorbidities, primary tumors located on the oral tongue, and lower depth of invasion compared to older smoker-drinker (SD) counterparts. Young patients were more likely to receive adjuvant chemoradiation compared to those > 40 years old (38% vs. 18%, p = 0.007). Age/smoking-drinking history was not significantly associated with disease-free survival or overall survival. On multivariate analysis, the following variables were associated with worse disease-free survival: higher N stage (N1 vs. N0 HR 2.46 [95% CI 1.46-4.17], p < 0.001; N2 vs. N0 HR 3.55 [2.25-5.59], p < 0.001; N3 vs. N0 HR 2.94 [1.76-4.91], p < 0.001) and diagnosis of hypothyroidism (HR 2.25 [1.56-3.24], p < 0.001). On multivariate analysis, the following were associated with worse overall survival: lower BMI (HR 1.48 [1.11-1.99], p = 0.008), heart failure (2.60 [1.68-4.02], p < 0.001), COPD (1.38 [1.05, 1.82], p = 0.021), perineural invasion (1.60 [1.23, 2.08], p < 0.001), and N-stage (N2 vs. N0 1.45 [1.05, 2.01], p = 0.025 and N3 vs. N0 2.27 [1.56-3.13], p < 0.001).

Despite higher rates of adjuvant chemoradiation and lower rates of comorbidities, young patients with no tobacco or alcohol history had comparable disease-free and overall survival compared to patients with traditional risk factors, including advanced age and tobacco and alcohol consumption.