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28.11.2016 | Head and Neck Oncology | Ausgabe 3/2017

Annals of Surgical Oncology 3/2017

Clinical Outcomes of Taiwanese Patients with cT4 Oral Cavity Squamous Cell Carcinoma: Toward the Identification of the Optimal Initial Treatment Approach for cT4b Patients

Annals of Surgical Oncology > Ausgabe 3/2017
MD Chun-Ta Liao, PhD Yu-Wen Wen, PhD Shu Ru Lee, MD Tsang-Wu Liu, MD Sen-Tien Tsai, MD Ming-Hsui Tsai, MD Jin-Ching Lin, MD, PhD Pei-Jen Lou, MD Pen-Yuan Chu, MD Yi-Shing Leu, MD Kuo-Yang Tsai, MD Shyuang-Der Terng, MD Tsung-Ming Chen, MD Cheng-Hsu Wang, MD Chih-Yen Chien, MD Wen-Cheng Chen, MD Li-Yu Lee, MD, PhD Chien-Yu Lin, MD Hung-Ming Wang, MD Shu-Hang Ng, MD Chih-Hung Lin, MD Tuan-Jen Fang, MD, PhD Shiang-Fu Huang, MD Chung-Jan Kang, MD, PhD Kai-Ping Chang, PhD Lan Yan Yang, MD, PhD Tzu-Chen Yen, for the Taiwan Oral Cancer Advisory Group
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1245/​s10434-016-5629-x) contains supplementary material, which is available to authorized users.
Chun-Ta Liao and Yu-Wen Wen contributed equally to this work.
Lan Yan Yang and Tzu-Chen Yen share senior authorship.



The National Comprehensive Cancer Network guidelines recommend that patients with oral cavity squamous cell carcinoma (OSCC) and cT4b disease should be either included in clinical trials or treated with a nonsurgical approach. However, surgery may be feasible in selected patients with adequate safety margins. Using the nationwide Taiwanese Cancer Registry Database, we examined the prognosis of cT4b OSCC patients in relation to their treatment approach.


Of the 18,910 patients with previously untreated first primary OSCC identified between 2004 and 2010, 492 (2.6 %) had cT4b tumors. Of them, 327 (66 %) received initial treatment with surgery, whereas 165 (34 %) were initially treated with a nonsurgical approach. Of the latter group, 78 patients subsequently underwent surgery. A 5-year disease-specific survival (DSS) ≥45 % was considered as a favorable outcome.


Better 5-year DSS and overall survival (OS) rates were observed in cT4b patients initially treated with surgery (vs. nonsurgery; DSS, 51 vs. 38 %; OS, 43 vs. 27 %, respectively, p < 0.001). Of the participants initially treated with surgery, patients with cN0–2 disease had better 5-year survival rates (DSS: cN0, 59 %; cN1, 53 %; cN2, 46 %; OS: cN0, 49 %; cN1, 50 %; cN2, 37 %) than those with cN3 disease (DSS: 0 %; OS: 0 %). Among cT4b patients who initially received a nonsurgical treatment, subjects who subsequently underwent surgery showed better outcomes.


Primary surgery is performed in approximately two-thirds of cT4b OSCC patients, with cN0–2 cases showing a good prognosis. Patients who initially received a nonsurgical approach can subsequently be treated with surgery and achieve favorable outcomes.

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Supplementary material 1 (DOC 28 kb)
Supplementary material 2 (DOC 32 kb)
Supplementary material 3 (DOC 32 kb)
Supplement Fig. 1 Kaplan-Meier plots of 5-year survival endpoints stratified according to the cN classification and the initial treatment approach (surgery versus non-surgery). Disease-specific survival for cT4a tumors (panel A); overall survival for cT4a tumors (panel B); disease-specific survival for cT4b tumors (panel C); and overall survival for cT4b tumors (panel D). Supplementary material 4 (TIFF 23143 kb)
Supplement Fig. 2 Multivariate Cox regression analysis of overall survival in patients with cT4b (panel A) and cT4a (panel B) tumors. Supplementary material 5 (TIFF 13465 kb)
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