Clinicopathological Parameters and Locoregional Recurrence in Oral Squamous Cell Carcinoma Patients

Abstract

ABSTRACT Objectives To study the clinicopathological parameters associated with recurrence of oral squamous carcinoma and analyze the survival of patients managed in ENT and Head and Neck Surgery Department between January 2008 and December 2013. Materials and methods Records of 178 cases were reviewed for clinical details, histopathological data, and follow-up status. Age, gender, addiction, subsite, T–N pathological staging, tumor thickness, margin status, grade of differentiation, lymphovascular permeation, perineural spread, and adjuvant therapy were analyzed. Results The recurrence rate was 13.5%. The median follow-up for the entire cohort was 20 months. Twenty-four patients had locoregional recurrence: 9 (37.5%) local recurrence alone, 11 (45%) regional recurrence alone, and 4 (17.5%) had both local and regional recurrence. The average time to recur in case of negative margin was 12.1 months, for close margin was 11.9 months, and with positive margin was 4.1 months. Looking at all patterns of recurrence, 4/98 (4%) of cases with negative margins, 15/65 (23%) cases with close margins, and 5/15 (33.3%) of those with positive margins recurred. Out of 24 cases of recurrence, 22 were sent for salvage surgery and others for salvage chemoradiation therapy. The Kaplan– Meier method and log-rank tests showed that the 2- and 5-years survival rates were significantly lower in the recurrence group compared with nonrecurrence group (78 vs 94%, 37 vs 66%, p < 0.001). Locoregional recurrence is strongly correlated with margin status according to univariate and multivariate analysis. Conclusion Among all clinicopathological parameters, the status of the surgical margin is the most important prognosticator. Good local control is mandatory to ensure patient's survival. Adequate margins at initial resection for complete clearance without the need of revision should be pursued by every surgeon. Although it is in surgeon's control, the achievement can be limited by the aggressiveness of the disease.