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Surgery Versus Radiotherapy in Older Adults with Oral Cavity Cancer: A Nationwide Comparative Effectiveness Study
Kuan-Chou Lin1,2, Chia-Lun Chang3,4, Wan-Ming Chen5,6
1Division of Oral and Maxillofacial Surgery, Department of Dentistry, Wan Fang Hospital, Taipei Medical University, Taiwan.
Summary
For older adults with oral cavity squamous cell carcinoma (OCSCC), curative-intent surgery offers better survival than radiation therapy. Age alone should not prevent surgical consideration for OCSCC patients.
Area of Science:
- Oncology
- Geriatric Medicine
- Surgical Oncology
Background:
- Older adults with oral cavity squamous cell carcinoma (OCSCC) are often excluded from clinical trials.
- The comparative effectiveness of surgery versus definitive radiotherapy with or without chemotherapy (RT±CT) for OCSCC in older adults is not well-established.
Purpose of the Study:
- To compare all-cause and OCSCC-specific mortality in older adults (≥65 years) with newly diagnosed OCSCC treated with curative-intent surgery versus definitive RT±CT.
Main Methods:
- A nationwide, population-based retrospective cohort study utilizing linked registry and claims data.
- Propensity score fine stratification weighting (PS-FSW) and multivariable Cox proportional hazards models were employed to mitigate treatment selection bias.
- Included were 1275 patients aged ≥65 years with nonmetastatic OCSCC diagnosed between 2009 and 2022.
Main Results:
- Surgery was associated with significantly lower all-cause mortality (aHR 0.59; 95% CI 0.51, 0.69) and OCSCC-specific mortality (aHR 0.63; 95% CI 0.51, 0.78) compared to definitive RT±CT.
- These survival benefits persisted across all age strata, including those aged 85 years and older.
- Baseline characteristics were well-balanced after PS-FSW analysis.
Conclusions:
- Curative-intent surgery demonstrated superior survival outcomes compared to definitive RT±CT for older adults with OCSCC.
- Chronological age should not be the sole factor in deciding against surgery; physiologic fitness and comprehensive geriatric assessments are crucial.
- Further research is recommended to evaluate treatment toxicity, functional outcomes, and quality of life.
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