Is Curative-Intent Primary Surgery Beneficial for Geriatric Oral Cavity Squamous Cell Carcinoma Patients?

Given the increasing incidence of oral cavity squamous cell carcinoma (OCSCC) among elderly patients, the optimal treatment for the elderly remains controversial. This study aimed to compare clinical features and outcomes between elderly (≥ 70 years) and younger patients with OCSCC undergoing curative surgery, focusing on the prognostic impact of age and tumor-related factors.

In this single-center retrospective study, patients aged ≥ 40 years who underwent curative resection for OCSCC between May 1996 and September 2023 were included. All received ≥ 1 cm surgical margins and neck dissection. Patients were stratified by age (40-69 years vs. ≥ 70 years). Clinicopathologic and treatment variables were compared between groups. Survival outcomes including 5-year disease-free survival (DFS) and overall survival (OS) were analyzed using Kaplan-Meier and Cox regression models.

Among 1744 OCSCC patients included, 1622 (93.0%) were 40-69 years and 122 (7.0%) were ≥ 70 years. Elderly patients had significantly better 5-year DFS (p = 0.035), while OS was comparable between groups (p = 0.495). Multivariable analysis showed age ≥ 70 years was independently associated with improved DFS (HR: 0.644; p = 0.044), but not OS (HR: 1.153; p = 0.392). Advanced T stage (HR: 1.757), nodal metastasis with extra-nodal extension (ENE) (HR: 2.443), and lymphatic invasion (HR: 1.969) were strong independent predictors of worse OS (all p < 0.001).

Carefully selected elderly OCSCC patients can achieve comparable OS and even favorable DFS. Prognosis is more strongly influenced by tumor-related pathological factors than by age, supporting treatment decisions for surgery-eligible elder patients based on functional reserve, overall health, and tumor biology rather than chronological age alone.