Background: Standardized staging procedures and presentation of oral squamous cell
carcinoma (OSCC) patients in multidisciplinary tumor boards (MDTB) before treatment
and utilization of elective neck dissection (ND) are expected to improve the outcome,
especially in local advanced LAOSCC (UICC stages III–IVB). As standardized diagnostics
but also increased heterogeneity in treatment applied so far have not been demonstrated
to improve outcome in LAOSCC, a retrospective study was initiated.
Methods: As MDTB was introduced into clinical routine in 2007, 316 LAOSCC patients
treated during 1991-2017 in our hospital were stratified into cohort 1 treated before
(n=104) and cohort 2 since 2007 (n=212). Clinical characteristics, diagnostic procedures
and treatment modality of patients were compared using Chi-square tests and outcome
analyzed applying Kaplan-Meier plots and log-rank tests as well as Cox proportional
hazard regression. Propensity scores (PS) were used to elucidate predictors for impaired
distant metastasis-free survival (DMFS) in PS-matched patients.
Results: Most patient characteristics and treatment modalities applied showed
insignificant alteration. Surgical treatment included significantly more often resection of
the primary tumor plus neck dissection, tracheostomy and percutaneous endoscopic
gastrostomy tube use. Cisplatin-based chemo-radiotherapy was the most frequent. Only
insignificant improved disease- (DFS), progression- (PFS) and event-free (EFS) as well as
tumor-specific (TSS) and overall survival (OS) were found after 2006 as local (LC) and locoregional
control (LRC) were significantly improved but DMFS significantly impaired.
Cox regression applied to PS-matched patients elucidated N3, belonging to cohort 2 and
cisplatin-based chemo-radiotherapy as independent predictors for shortened DMFS. The
along chemo-radiotherapy increased dexamethasone use in cohort 2 correlates with
increased DM.
Conclusions: Despite standardized diagnostic procedures, decision-making considering
clear indications and improved therapy algorithms leading to improved LC and LRC,
shortened DMFS hypothetically linked to increased dexamethasone use had a detrimental
effect on TSS and OS.
| Identifer | oai:union.ndltd.org:DRESDEN/oai:qucosa:de:qucosa:84398 |
| Date | 30 March 2023 |
| Creators | Wichmann, Gunnar, Pavlychenko, Mykola, Willner, Maria, Halama, Dirk, Kuhnt, Thomas, Kluge, Regine, Gradistanac, Tanja, Fest, Sandra, Wald, Theresa, Lethaus, Bernd, Dietz, Andreas, Wiegand, Susanne, Zebralla, Veit |
| Publisher | Frontiers Research Foundation |
| Source Sets | Hochschulschriftenserver (HSSS) der SLUB Dresden |
| Language | English |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, doc-type:article, info:eu-repo/semantics/article, doc-type:Text |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 2234-943X, 737080 |
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