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Abstract
BACKGROUND:
Up to half of patients with oral cavity squamous cell carcinoma (OCSCC) have stage I to II disease. When adequate resection is attained, no further treatment is needed; however, re-resection or radiotherapy may be indicated for patients with positive or close margins. This multicenter study evaluated the outcomes and role of adjuvant treatment in patients with stage I to II OCSCC.

METHODS:
Overall survival (OS), disease-specific survival, local-free survival, and disease-free survival rates were calculated with Kaplan-Meier analysis.

RESULTS:
Of 1257 patients with T1-2N0M0 disease, 33 (2.6%) had positive margins, and 205 (16.3%) had close margins. The 5-year OS rate was 80% for patients with clear margins, 52% for patients with close margins, and 63% for patients with positive margins (P < .0001). In a multivariate analysis, age, depth of invasion, and margins were independent predictors of outcome. Close margins were associated with a >2-fold increase in the risk of recurrence (P < .0001). The multivariate analysis revealed that adjuvant treatment significantly improved the outcomes of patients with close/positive margins (P = .002 to .03).

CONCLUSIONS:
Patients with stage I to II OCSCC and positive/close margins have poor long-term outcomes. For this population, adjuvant treatment may be associated with improved survival. Cancer 2018;124:2948-55. © 2018 American Cancer Society

Author information

Fridman E1,2, Na'ara S1,2, Agarwal J3, Amit M1,2, Bachar G4, Villaret AB5, Brandao J6, Cernea CR6, Chaturvedi P3, Clark J7,8, Ebrahimi A7,8,9, Fliss DM10, Jonnalagadda S11, Kohler HF12, Kowalski LP13, Kreppel M14, Liao CT15, Patel SG16, Patel RS17, Robbins KT18, Shah JP16, Shpitzer T4, Yen TC15, Zöller JE14, Gil Z1,2; International Consortium for Outcome Research in Head and Neck Cancer.
1
Rambam Healthcare Campus, Technion-Israel Institute of Technology, Haifa, Israel.
2
Laboratory for Applied Cancer Research, Technion-Israel Institute of Technology, Haifa, Israel.
3
Tata Memorial Hospital, Mumbai, India.
4
Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel.
5
Ear, Nose, and Throat Department, University of Brescia, Brescia, Italy.
6
Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil.
7
Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
8
Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia.
9
University of New South Wales, Sydney, New South Wales, Australia.
10
Department of Otolaryngology-Head and Neck Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.
11
Southern Illinois University School of Medicine, Springfield, Illinois.
12
Department of Head and Neck Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil.
13
A. C. Camargo Cancer Center, São Paulo, Brazil.
14
Department of Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Cologne, Germany.
15
Chang Gung Memorial Hospital, Taoyuan, Taiwan.
16
Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York.
17
University of Auckland, Auckland, New Zealand.
18
Southern Illinois University School of Medicine, Carbondale, Illinois.