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Postoperative radiation performed at the same surgical facility associated with improved overall survival in oral cavity squamous cell carcinoma.

ABSTRACT: BACKGROUND:The purpose of this analysis is to evaluate whether postoperative radiotherapy (PORT) at the same facility as surgery portends to better survival outcomes compared to PORT given at a different facility. METHODS:Patients underwent upfront surgery at the National Cancer Database reporting facility followed by PORT. PORT was coded as performed at either the same facility or at a different facility as surgery. RESULTS:A total of 10 832 patients were selected. Five-year overall survival (OS) was higher in patients undergoing PORT at the same facility: 52.5% vs 48.4% (P < 0.001). PORT performed at the same facility was associated with improved OS under multivariate (HR, 0.92; P = 0.01) and propensity score matched (hazard ratio, 0.90; P = 0.004) analyses. CONCLUSIONS:OS was better among patients with head and neck cancer who received PORT at the same facility as surgery.

SUBMITTER: Amini A

PROVIDER: S-EPMC6886367 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Postoperative radiation performed at the same surgical facility associated with improved overall survival in oral cavity squamous cell carcinoma.

Amini Arya A Stokes William A WA Jones Bernard L BL Sampath Sagus S Kang Robert S RS Gernon Thomas J TJ Maghami Ellie G EG Massarelli Erminia E Bradley Cathy J CJ Karam Sana D SD

Head & neck 20190209 7

<h4>Background</h4>The purpose of this analysis is to evaluate whether postoperative radiotherapy (PORT) at the same facility as surgery portends to better survival outcomes compared to PORT given at a different facility.<h4>Methods</h4>Patients underwent upfront surgery at the National Cancer Database reporting facility followed by PORT. PORT was coded as performed at either the same facility or at a different facility as surgery.<h4>Results</h4>A total of 10 832 patients were selected. Five-ye ...[more]

PMID: 30737961

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Project description:ImportanceOral cavity squamous cell carcinoma (SCC) tumors with mandibular invasion are upstaged to pT4a regardless of their size. Even small tumors with boney invasion, which would otherwise be classified as pT1-2, are recommended for the locally advanced treatment pathway to receive administration of postoperative radiotherapy (PORT).ObjectiveTo evaluate the association of PORT with overall survival according to tumor size among patients who received mandibulectomy for pT4aN0 oral cavity SCC.Design, setting, and participantsThis was a retrospective analysis using data from the US National Cancer Database from January 1, 2004, through December 31, 2019. All patients who received mandibulectomy for treatment-naive pT4aN0 oral cavity SCC with negative surgical margins were included. Data analyses were performed in January 2023 and finalized in July 2023.ExposurePORT vs no PORT.Main outcomes and measuresEntropy balancing was used to balance covariate moments between treatment groups. Weighted multivariable Cox proportional hazards regression was used to measure the association of PORT with overall survival associated with tumor size.ResultsAmong 3268 patients with pT4aN0 oral cavity SCC (mean [SD] age, 65.9 [12.1] years; 2024 [61.9%] male and 1244 [38.1%] female), 1851 (56.6%) received PORT and 1417 (43.4%) did not receive PORT. On multivariable analysis was adjusted for age, insurance status, Charlson Comorbidity Index score, tumor site, tumor grade, tumor size, and PORT. Findings indicated that PORT was associated with improved overall survival and that this relative survival advantage trended upwards with increasing tumor size. That is, the larger the tumor, the greater the survival advantage associated with the use of PORT. For the 1068 patients with tumors greater than 4 cm, the adjusted hazard ratio (aHR) in favor of PORT was 0.63 (95% CI, 0.48-0.82); for the 1774 patients with tumors greater than 2 cm but less than or equal to 4 cm, the aHR was 0.76 (95% CI, 0.62-0.93); and for 426 patients with tumors less than 2 cm, the aHR was 0.81 (95% CI, 0.57-1.15).Conclusions and relevanceIn this retrospective analysis of patients who received mandibulectomy for pT4aN0 oral cavity SCC, PORT was associated with improved overall survival, the benefit of which improved relatively with increasing tumor size. These findings suggest that tumor size should be considered in guidelines for PORT administration in this patient population.

Dataset Information

Postoperative radiation performed at the same surgical facility associated with improved overall survival in oral cavity squamous cell carcinoma.

Publications

Postoperative radiation performed at the same surgical facility associated with improved overall survival in oral cavity squamous cell carcinoma.

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