Surgery Versus Radiotherapy in Older Adults with Oral Cavity Cancer: A Nationwide Comparative Effectiveness Study

Older adults with oral cavity squamous cell carcinoma (OCSCC) are underrepresented in clinical trials, and the comparative effectiveness of surgery versus definitive radiotherapy with or without chemotherapy (RT ± CT) remains uncertain.

To compare all-cause and OCSCC-specific mortality after curative-intent surgery versus definitive RT ± CT in older adults with newly diagnosed OCSCC.

Nationwide, population-based retrospective cohort study using linked registry and claims data. Propensity score fine stratification weighting (PS-FSW) and multivariable Cox proportional hazards models were used to reduce treatment selection bias.

Taiwan Cancer Registry, National Health Insurance Research Database, and Taiwan Death Registry.

Patients aged ≥65 years with newly diagnosed, nonmetastatic, pathologically confirmed OCSCC between January 1, 2009, and December 31, 2022.Intervention or Exposures:Curative-intent surgery, with or without adjuvant therapy, compared with definitive RT ± CT delivered with curative-intent.

All-cause mortality and OCSCC-specific mortality.

Among 1275 eligible patients, 492 underwent curative-intent surgery and 783 received definitive RT ± CT. After PS-FSW, baseline characteristics were well balanced. Surgery was associated with lower all-cause mortality (adjusted hazard ratio [aHR] 0.59; 95% confidence interval [CI] 0.51, 0.69; P < .0001) and lower OCSCC-specific mortality (aHR 0.63; 95% CI 0.51, 0.78; P < .0001) compared with definitive RT ± CT. The survival benefit persisted across age strata, including patients aged ≥85 years.

Curative-intent surgery was associated with superior all-cause and cancer-specific survival compared with definitive RT ± CT among older adults with OCSCC.

Chronological age alone should not preclude surgical consideration in older adults with OCSCC. Treatment decisions should incorporate physiologic fitness, comorbidity burden, geriatric assessment, and multidisciplinary evaluation; future studies should further evaluate treatment-related toxicity, functional outcomes, and quality-of-life.