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Abstract：
OBJECTIVE: To identify prognostic factors for patients with advanced persistent, recurrent, or 2nd primary oral cavity squamous cell carcinoma (OCSCC) potentially unsuitable for salvage surgery with free tissue flap (FTF) reconstruction.
METHODS: A population-based cohort of 83 consecutive patients with advanced OCSCC who underwent salvage surgery with FTF reconstruction at a tertiary referral centre between 1990 and 2017. Retrospective uni- and multivariable analyses were performed to identify factors affecting all-cause mortality (ACM), i.e., overall survival (OS), as well as disease-specific mortality (DSM), i.e., disease-specific survival (DSS) after salvage surgery.
RESULTS: Median disease-free interval until recurrence was 15 months with recurrent stage I/II in 31% and III/IV in 69%. Median age at salvage surgery was 67 years (range 31-87) and the median follow-up (alive patients) 126 months. At 2, 5, and 10 years after salvage surgery, respectively, DSS rates were 61%, 44%, and 37% and OS rates 52%, 30%, and 22%. Median DSS was 26 and OS 43 months. Multivariable analysis identified recurrent clinical regional (cN-plus) disease [HR 3.57; p < .001] and elevated gamma-glutamyl transferase (GGT) [HR 3.30; p = .003] as independent pre-salvage predictors for poor OS after salvage, whereas initial cN-plus [HR 2.07; p = .039] and recurrent cN-plus disease [HR 5.14; p < .001] predicted poor DSS. Among post-salvage factors, extranodal extension according to histopathology [HR ACM 6.11; HR DSM 9.99; p < .001] as well as positive [HR ACM 4.98; DSM 7.51; p < 0.001] and narrow surgical margins [HR ACM 2.12; DSM HR 2.80; p < 0.01] emerged as independent factors for poor survival.
CONCLUSIONS: While salvage surgery with FTF reconstruction is the primary curative option for patients with advanced recurrent OCSCC, the present findings may help guide discussions with patients who have advanced recurrent regional disease and high GGT preoperatively, especially if there is a small chance of reaching surgical radicality.
METHODS: A population-based cohort of 83 consecutive patients with advanced OCSCC who underwent salvage surgery with FTF reconstruction at a tertiary referral centre between 1990 and 2017. Retrospective uni- and multivariable analyses were performed to identify factors affecting all-cause mortality (ACM), i.e., overall survival (OS), as well as disease-specific mortality (DSM), i.e., disease-specific survival (DSS) after salvage surgery.
RESULTS: Median disease-free interval until recurrence was 15 months with recurrent stage I/II in 31% and III/IV in 69%. Median age at salvage surgery was 67 years (range 31-87) and the median follow-up (alive patients) 126 months. At 2, 5, and 10 years after salvage surgery, respectively, DSS rates were 61%, 44%, and 37% and OS rates 52%, 30%, and 22%. Median DSS was 26 and OS 43 months. Multivariable analysis identified recurrent clinical regional (cN-plus) disease [HR 3.57; p < .001] and elevated gamma-glutamyl transferase (GGT) [HR 3.30; p = .003] as independent pre-salvage predictors for poor OS after salvage, whereas initial cN-plus [HR 2.07; p = .039] and recurrent cN-plus disease [HR 5.14; p < .001] predicted poor DSS. Among post-salvage factors, extranodal extension according to histopathology [HR ACM 6.11; HR DSM 9.99; p < .001] as well as positive [HR ACM 4.98; DSM 7.51; p < 0.001] and narrow surgical margins [HR ACM 2.12; DSM HR 2.80; p < 0.01] emerged as independent factors for poor survival.
CONCLUSIONS: While salvage surgery with FTF reconstruction is the primary curative option for patients with advanced recurrent OCSCC, the present findings may help guide discussions with patients who have advanced recurrent regional disease and high GGT preoperatively, especially if there is a small chance of reaching surgical radicality.
摘要：
目的：确定晚期持续性患者的预后因素，经常性,或第二原发性口腔鳞状细胞癌（OCSCC）可能不适合进行游离组织瓣（FTF）重建的抢救手术。
方法：一项以人群为基础的队列研究，其中83例晚期OCSCC患者于1990年至2017年间在三级转诊中心接受了FTF重建的抢救手术。进行回顾性单变量和多变量分析，以确定影响全因死亡率（ACM）的因素，即，总生存期（OS），以及疾病特异性死亡率(DSM)，即，抢救手术后的疾病特异性生存率（DSS）。
结果：直至复发的中位无病间隔为15个月，复发I/II期占31％，III/IV期占69％。抢救手术的中位年龄为67岁（范围31-87），中位随访（活着的患者）为126个月。在抢救手术后2年、5年和10年，分别,DSS率为61%,44%,37%和操作系统率52%，30%,和22%。平均DSS为26个月，OS为43个月。多变量分析确定了复发性临床区域（cN+）疾病[HR3.57;p<.001]和升高的γ-谷氨酰转移酶（GGT）[HR3.30;p=.003]作为抢救后不良OS的独立抢救前预测因子，而初始cN+[HR2.07;p=.039]和复发性cN+疾病[HR5.14;p<.001]预测不良DSS。在救助后因素中，根据组织病理学[HRACM6.11;HRDSM9.99;p<.001]以及阳性[HRACM4.98;DSM7.51;p<0.001]和狭窄的手术边缘[HRACM2.12;DSMHR2.80;p<0.01]显示为生存不良的独立因素。
结论：虽然FTF重建的抢救手术是晚期复发性OCSCC患者的主要治疗选择，目前的研究结果可能有助于指导讨论谁有晚期复发性区域疾病和高GGT术前，特别是如果有一个小的机会达到手术的激进主义。
方法：一项以人群为基础的队列研究，其中83例晚期OCSCC患者于1990年至2017年间在三级转诊中心接受了FTF重建的抢救手术。进行回顾性单变量和多变量分析，以确定影响全因死亡率（ACM）的因素，即，总生存期（OS），以及疾病特异性死亡率(DSM)，即，抢救手术后的疾病特异性生存率（DSS）。
结果：直至复发的中位无病间隔为15个月，复发I/II期占31％，III/IV期占69％。抢救手术的中位年龄为67岁（范围31-87），中位随访（活着的患者）为126个月。在抢救手术后2年、5年和10年，分别,DSS率为61%,44%,37%和操作系统率52%，30%,和22%。平均DSS为26个月，OS为43个月。多变量分析确定了复发性临床区域（cN+）疾病[HR3.57;p<.001]和升高的γ-谷氨酰转移酶（GGT）[HR3.30;p=.003]作为抢救后不良OS的独立抢救前预测因子，而初始cN+[HR2.07;p=.039]和复发性cN+疾病[HR5.14;p<.001]预测不良DSS。在救助后因素中，根据组织病理学[HRACM6.11;HRDSM9.99;p<.001]以及阳性[HRACM4.98;DSM7.51;p<0.001]和狭窄的手术边缘[HRACM2.12;DSMHR2.80;p<0.01]显示为生存不良的独立因素。
结论：虽然FTF重建的抢救手术是晚期复发性OCSCC患者的主要治疗选择，目前的研究结果可能有助于指导讨论谁有晚期复发性区域疾病和高GGT术前，特别是如果有一个小的机会达到手术的激进主义。
