The role of adjuvant treatment in early-stage oral cavity squamous cell carcinoma: An international collaborative study

Cancer. 2018 Jul 15;124(14):2948-2955. doi: 10.1002/cncr.31531. Epub 2018 May 14.


Background: Up to half of patients with oral cavity squamous cell carcinoma (OCSCC) have stage I to II disease. When adequate resection is attained, no further treatment is needed; however, re-resection or radiotherapy may be indicated for patients with positive or close margins. This multicenter study evaluated the outcomes and role of adjuvant treatment in patients with stage I to II OCSCC.

Methods: Overall survival (OS), disease-specific survival, local-free survival, and disease-free survival rates were calculated with Kaplan-Meier analysis.

Results: Of 1257 patients with T1-2N0M0 disease, 33 (2.6%) had positive margins, and 205 (16.3%) had close margins. The 5-year OS rate was 80% for patients with clear margins, 52% for patients with close margins, and 63% for patients with positive margins (P < .0001). In a multivariate analysis, age, depth of invasion, and margins were independent predictors of outcome. Close margins were associated with a >2-fold increase in the risk of recurrence (P < .0001). The multivariate analysis revealed that adjuvant treatment significantly improved the outcomes of patients with close/positive margins (P = .002 to .03).

Conclusions: Patients with stage I to II OCSCC and positive/close margins have poor long-term outcomes. For this population, adjuvant treatment may be associated with improved survival. Cancer 2018;124:2948-55. © 2018 American Cancer Society.

Keywords: margins; oral cavity; squamous cell carcinoma; survival.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Chemoradiotherapy, Adjuvant / methods
  • Disease-Free Survival
  • Female
  • Humans
  • International Cooperation
  • Kaplan-Meier Estimate
  • Male
  • Margins of Excision*
  • Middle Aged
  • Mouth / pathology
  • Mouth / surgery
  • Mouth Neoplasms / mortality
  • Mouth Neoplasms / pathology
  • Mouth Neoplasms / therapy*
  • Neoplasm Invasiveness
  • Neoplasm Recurrence, Local / epidemiology
  • Neoplasm Recurrence, Local / prevention & control*
  • Neoplasm Staging
  • Prognosis
  • Radiotherapy, Adjuvant / methods
  • Retreatment / statistics & numerical data
  • Retrospective Studies
  • Squamous Cell Carcinoma of Head and Neck / mortality
  • Squamous Cell Carcinoma of Head and Neck / pathology
  • Squamous Cell Carcinoma of Head and Neck / therapy*