Nomograms for preoperative prediction of prognosis in patients with oral cavity squamous cell carcinoma.

BACKGROUND: This study sought to develop prognostic tools that will accurately predict overall and cancer-related mortality and risk of recurrence in individual patients with oral cancer based on host and tumor characteristics. These tools would take into account numerous prognosticators beyond those covered by the traditional TNM (tumor-node-metastasis) staging system. METHODS: Demographic, host, and tumor characteristics of 1617 patients with cancer of the oral cavity, who were treated primarily with surgery at a single-institution tertiary care cancer center between 1985 and 2009, were reviewed from a preexisting database. Recurrent disease was recorded in 509 patients (456 locoregional and 116 distant); 328 patients died of cancer-related causes, and 542 died of other causes. The median follow-up was 42 months (range, 1-300 months). The following variables were analyzed as predictors of prognosis: age, sex, race, alcohol and tobacco use, oral cavity subsite, invasion of other structures, comorbidity, tumor size, and clinical nodal status. The stepdown method was used to select the statistically most influential predictors for inclusion in the final nomogram for each outcome of interest. RESULTS: The most influential predictors of both recurrence and cancer-specific mortality probability (CSMP) were tumor size, nodal status, subsite, and bone invasion. Nomograms were generated for prediction of overall survival (OS), CSMP, and locoregional recurrence-free probability (LRRFP). The nomograms were internally validated with an overfit-corrected predictive discrimination metric (concordance index) for OS of 67%, CSMP of 66%, and LRRFP of 60%. CONCLUSIONS: Nomograms have been developed that can reasonably estimate OS, CSMP, and LRRFP based on specific tumor and host characteristics in patients with oral cancer.

A novel tumor: specimen index for assessing adequacy of resection in early stage oral tongue cancer.

PURPOSE: Surgical margin status frequently affects decisions regarding adjuvant treatment; however, reporting and interpretation of surgical margins is subject to considerable subjectivity because of many factors including the adequacy of resection. We developed a novel measure of the adequacy of surgical resection, the tumor: specimen index (TSI), and tested its utility at predicting clinical outcomes in a retrospective cohort study. PATIENTS AND METHODS: An institutional database was queried to identify previously untreated patients with T1 and T2 oral tongue cancer who underwent surgery during 1985-2009 (n=433). The TSI, a geometric mean representing the percentage of the surgical specimen that is occupied by the tumor in average single dimension, was calculated from the largest measured lengths, widths, and heights of the tumor in relation to the entire surgical specimen. Multivariate analyses of locoregional recurrence-free probability (LRRFP) and disease-specific survival (DSS) were performed with commonly accepted prognosticators in addition to TSI and surgical margins status. RESULTS: The mean TSI was 41 (range 11-90; SD 14). Surgical margin status was associated with TSI; margins were negative in 84% of patients with TSI<45 and in 63% of patients with TSI⩾45 (p<0.001). TSI⩾45 was associated with worse LRRFP (57% vs. 76%, p<0.001) and worse DSS (68% vs. 85%, p<0.001). In a multivariate analysis that did not include TSI, surgical margin status independently predicted LRRFP (p=0.014) but not DSS. When TSI was included, only TSI, and not surgical margin status, was an independent predictor of both LRRFP (p=0.002) and DSS (p=0.011). CONCLUSION: The tumor: specimen index is an easily-calculated metric for estimating the adequacy of 3-dimensional resection in T1 and T2 oral tongue cancer that independently predicts oncologic outcomes.

Changing trends in smoking and alcohol consumption in patients with oral cancer treated at Memorial Sloan-Kettering Cancer Center from 1985 to 2009.

OBJECTIVE: To describe smoking and alcohol consumption trends in patients with oral cavity cancer over the past 25 years. DESIGN: Retrospective cohort study. SETTING: Single-institution tertiary care cancer center. PATIENTS: Patients with oral cancer treated primarily with surgery from 1985 to 2009. Patients with previous head and neck cancer were excluded. MAIN OUTCOME MEASURES: The medical records of 1617 patients were reviewed. Patient demographics and details on smoking and alcohol consumption were recorded. Patients were divided in 5 different cohorts according to the year of initial surgery. RESULTS: There were no differences in sex, age, or stage of disease among cohorts. Oral tongue was the most common subsite (49%). There was a progressive decrease in tobacco use; 80% in cohort 1 vs 60% in cohort 5 (P < .001). A decrease in the daily amount of tobacco used was also found; 55% of patients in cohort 1 smoked more than 1 pack per day compared with 30% in cohort 5 (P < .001). Alcohol consumption decreased from 80% in cohort 1 to 67% in cohort 5 (P < .007). The percentage of patients who consumed more than 3 drinks per day decreased from 23% in cohort 1 to 9% in cohort 5 (P < .001). CONCLUSION: Over the past 25 years there has been a progressive decrease in the prevalence of tobacco and alcohol users in patients with oral cancer.