Basic and patient-oriented research
Clinical and Histopathologic Independent Prognostic Factors in Oral Squamous Cell Carcinoma: A Retrospective Study of 334 Cases

https://doi.org/10.1016/j.joms.2007.12.024Get rights and content

Purpose

This retrospective hospital-based study reviewed and evaluated the outcome of patients with oral squamous cell carcinoma (OSCC) with the aim of identifying factors affecting the clinical course and survival rate.

Patients and Methods

Patients with a follow-up of at least 12 months were included. The data collected were statistically analyzed for the presence of factors valuable for prognosis; survival curves were processed in accordance with the Kaplan-Meier method. Differences in the expression of variables in different grading levels were investigated. Cox's proportional hazard model for Zi covariates (grading, age, T, N) also was calculated.

Results

Mean patient age was 67.7 years in women (n = 152) and 62.4 years in men (n = 182). A total of 98 patients were identified with Broder's/World Health Organization grade 1 histology, 176 with grade 2, and 55 with grade 3; 5 patients were identified as grade 4 (carcinoma in situ). Gender and risk factors seemed to be unrelated to prognosis, whereas a significant increase in mortality was seen in patients over age 70. Histological grading, tumor size, and neck involvement were related, as independent factors, in predicting survival in patients with OSCC (QM-H > 3.9). Gender, age, and risk factors had no statistical relationship with cancer histological differentiation.

Conclusions

Our analysis reveals a statistically significant relationship among histological Broder's grading of malignancy, tumor size, locoregional involvement, and survival rates, underscoring the utility of tumor differentiation in predicting the clinical course and outcome of OSCC.

Section snippets

Patients and Methods

From a standardized computerized database,7 the case records of 347 patients diagnosed with OSCC at the Oral Medicine Section, University of Turin over a 10-year period (June 1, 1994, to June 1, 2004) were retrospectively reviewed. The study cohort included patients with histologically confirmed diagnosis of OSCC, a minimum follow-up of 12 months, and a computerized digital file.

The data evaluated for each patient included demographic information, agreement of histological diagnosis between the

Statistical Analysis

A descriptive analysis was performed on age, gender, risk factor exposure, localization of lesions, T stage, histopathologic grading, therapy, and follow-up. Continuous variables are expressed as mean ± standard deviation. Kaplan-Meier analysis was performed to determine the probability of survival. Estimated mortality rates, λ, and survival to 60 to 120 months were computed; survival curves were constructed using product limit estimation (Table 2). Survival curves A and B (with λA = θ · λB, with

Patient Characteristics

A total of 334 cases of OSCC were studied in 182 men and 152 women (mean age, 66.90 ± 11.72 years). Average age at diagnosis was 67.7 ± 13.9 years in the women and 62.4 ± 13.3 years in the men. The TNM staging system identified the following lesion categories: T1 (n = 144), T2 (n = 85), T3 (n = 26), and T4 (n = 79). N stage also was recorded (Table 2, in which N4 means NX).8 Histological analysis of the biopsy specimens revealed 98 well-differentiated, 176 moderately differentiated, and 55

Outcome

During the study period, 80 patients (23.9%) died due to tumor. No recurrence was seen in 235 patients (70.3%). Recurrence developed in 99 patients (29.7%), of whom 39 had been treated by surgery, 8 by radiotherapy, and 53 by surgery plus radiotherapy. The overall cumulative survival rate was 76.8% at 5 years after the initial diagnosis, and 59% at 10 years (Table 2).

Survival curves for OSCC according to gender (P = .13) and risk factors (smoking, P = .16; alcohol use, P = .98) exhibited no

Discussion

OSCC is one of the most complex malignancies to control, and only slight improvement in the survival rate has been achieved over the last several decades. The present study was conducted to analyze certain factors that apparently exert some influence on survival.

The clinical course of a patient with OSCC is determined by specific primary tumor factors, host characteristics, and, naturally, the type of treatment applied. One important tumor factor to take into consideration is histopathologic

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