Comparison of Treatment Outcomes in Clinical Early-stage Oral Squamous Cell Carcinoma of the Buccal Mucosa and Oral tongue-A Retrospective Cohort Study

Purpose: To compare the treatment outcome between different surgical strategies in clinical early-stage oral squamous cell carcinoma of buccal mucosa (BM) and oral tongue (OT). Methods: Retrospective analysis of 310 patients of cT1-2N0 who underwent different surgeries (wide excision with or without neck dissection). Overall survival rate (OS) and disease-free survival rate (DFS) were calculated, and multivariate analysis was performed for determining risk factors. Results: The 5-year OS of the BM and OT group both was 80.2%, and the 5-year DFS of the BM and OT group was 61.8% and 67.3%, respectively. The is no significant difference between the OS of WE and ND groups. The positive extranodal extension (ENE) and histologic tumor grade (pG) were the major hazard factors that affect OS. Moreover, ENE, pG, and depth of invasion >5 mm impacted the DFS significantly. The OT cT2N0 group has the highest occult metastatic rate, which is 20.4%, followed by BM cT2N0, OT cT1N0, and BM cT1N0, the rate was 20.0%, 17.4%, 13.5%, respectively. Conclusion: The 5-year OS of the OT cT2N0 WE group was 50.0% which is much lower than the ND group's 82.9%, and the occult metastatic rate in BM and OT cT2 groups was both over 20%. Additionally, pG, ENE, and DOI were stronger predictors of both OS and DFS. Therefore, we recommend END should be carefully evaluated according to risk factors in cT2N0 patients for survival improvement. By incorporating these parameters, we can improve precision in the surgical decision and lead to better outcomes.

關鍵字

Early-stage oral squamous cell carcinoma ； Survival rate ； Occult metastatic rate ； Elective neck dissection ； Risk factors

並列摘要

目的：比較不同手術策略對臨床早期口腔頰黏膜或舌部鱗狀細胞癌的治療效果。方法：針對310例接受不同手術（單獨廣泛性切除或廣泛性切除合併頸部淋巴廓清術）的臨床一到二期患者進行病歷回顧分析。計算整體存活率和無病存活率，並進行多變量回歸分析以確定危險因子。結果：頰黏膜和舌部5年整體存活率皆為80.2%，5年無病存活率分別為61.8%和67.3%。不同手術策略組別之間的整體存活率沒有顯著差異。陽性淋巴結外侵犯和較高組織學腫瘤分級是影響存活率的主要危險因素。此外，陽性淋巴結外侵犯，較高組織學腫瘤分級和腫瘤浸潤深度>5釐米皆會顯著影響無病存活率。舌部臨床二期淋巴隱匿轉移率最高，為20.4%，其次為頰黏膜臨床二期、舌部臨床一期和頰黏膜臨床一期，分別為20.0%、17.4%、13.5%。結論：舌部臨床二期只切除腫瘤的組別5年存活率為50.0%，低於有進行淋巴廓清術的組別82.9%，且臨床二期頰黏膜與舌部兩組淋巴隱匿轉移率皆超過20%。此外，對存活率及無病存活率來說，淋巴結外侵犯、組織學腫瘤分級和腫瘤浸潤深度皆是非常有力的危險因子。因此，我們建議對於臨床二期患應該謹慎評估危險因子並考慮實施預防性頸部淋巴廓清術以增進存活率。藉由術前全面評估這些危險因子，我們可以提高手術決策的準確性並讓病人獲得較好的預後。

並列關鍵字

早期口腔鱗狀細胞癌；存活率；淋巴隱匿轉移率；選擇性頸部淋巴廓清術；危險因子

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