Journal of Prevention and Treatment for Stomatological Diseases ›› 2020, Vol. 28 ›› Issue (8): 487-493.doi: 10.12016/j.issn.2096-1456.2020.08.002

• Special Articles • Previous Articles     Next Articles

Analysis of clinicopathological characteristics and survival of 1 915 oral cavity squamous cell carcinoma patients: 24-year experience from a single institution

CHEN Shuwei,YANG Ankui,ZHANG Quan,CHEN Wenkuan,LI Hao,LI Qiuli,CHEN Yanfeng,CHEN Weichao,YANG Zhongyuan,ZHANG Xing,SONG Ming()   

  1. Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
  • Received:2018-12-07 Revised:2020-03-28 Online:2020-08-20 Published:2020-07-15
  • Contact: Ming SONG E-mail:songming@sysucc.org.cn

Abstract:

Objective To investigate the clinicopathological features and survival rate of oral squamous cell carcinoma patients in China. Methods The clinicopathological characteristics, stage, treatment modality, and 5-year disease-specific survival (DSS) rate of 1 915 OCSCC patients who received initial treatment at the Sun Yat-sen University Cancer Center from 1990 to 2013 were collected and analyzed. The clinicopathological characteristics, stage, treatment modality, and 5-year disease-specific survival (DSS) rate of OCSCC patients treated during the successive decades of 1990-1999, 2000-2009, and 2010-2013 were analyzed retrospectively to show the trends over time. Results The average age of all OCSCC patients who received initial treatment at this cancer center from 1990 to 2013 was 54.8 years (SD, 12.6 years). The sex ratio was approximately 2:1. The oral tongue was the site most prone for OCSCC, accounting for 63.6% of all cases. The proportions of early-stage (Ⅰ-Ⅱ) and advanced-stage (Ⅲ-Ⅳ) cases were approximate. Regarding the treatment modality, surgery-based treatment accounted for 80.4%. Survival analysis showed that the 5-year DSS rate of all cases was 57%. Survival decreased with age. The survival of females, nonsmokers, and nondrinkers was higher than that of males, smokers, and drinkers. The 5-year DSS rates of patients with squamous cell carcinoma of the lips, oral tongue, and other sites of the oral cavity were 81%, 63%, and 42%, respectively. The 5-year DSS rates of patients who received surgery-based treatment and nonsurgical treatment were 66% and 19%, respectively. The analysis of trends over time showed that in the period of 1990-1999 and 2010-2013, the age and sex ratio were relatively stable. The proportion of patients with squamous cell carcinoma of the lips and oral tongue gradually decreased, while the proportion of those with squamous cell carcinoma of the other sites of the oral cavity gradually increased. The proportion of surgery-based treatment increased from 77.7% to 91.3%. The 5-year DSS rate gradually increased from 53% in 1990-1999 to 64% in 2010-2013. The 5-year DSS rate of female patients increased significantly from 55% to 78%. However, the 5-year DSS rate of male patients was relatively stable. The 5-year DSS rate of patients who received surgery-based treatment gradually increased from 62% to 69%. Conclusion The 5-year DSS rate has steadily improved for OCSCC patients at this cancer center from 1990-2013, especially in female patients. The 5-year DSS rate of patients with squamous cell carcinoma of the oral tongue has reached the rate in developed countries worldwide. The proportion and survival rate of patients who received surgery-based treatment gradually increased. The survival rate of patients with squamous cell carcinoma of the other sites of the oral cavity was significantly lower than that of patients with squamous cell carcinoma of the lips and oral tongue, suggesting that more effort should be put into the treatment of patients with squamous cell carcinoma of the other sites of the oral cavity to improve the survival rate in the future.

Key words: cancer, squamous cell, oral cavity, tongue, lip, clinicopathological characteristics, survival, disease-specific survival, treatment modality

CLC Number: 

  • R78

Table 1

The clinicopathological characteristics and TNM stages of oral cavity squamous cell carcinoma patient n(%)"

Total 1990-1999 2000-2009 2010-2013 χ2 P
Variants Total 1 915 638 850 427
Age x ± s 54.8 ± 12.6 54.6 ± 12.9 54.7 ± 12.4 55.5 ± 12.8 0.730 0.483
Gender Male 1 299(67.8) 450(70.5) 558(65.7) 291(68.2) 4.013 0.135
Female 616(32.2) 188(29.5) 292(34.4) 136(31.9)
Site Oral tongue 1 218(63.6) 414(64.9) 544(64.0) 260(60.9) 8.759 0.067
Other parts 647(33.8) 200(31.4) 287(33.8) 160(37.5)
Lip 50(2.6) 24(3.8) 19(2.2) 7(1.6)
Smoking No 753(39.3) 295(46.2) 209(24.6) 249(58.3) 387.811 <0.001
Yes 836(43.7) 331(51.9) 347(40.8) 158(37.0)
Unknown 326(17.0) 12(1.9) 294(34.6) 20(4.7)
Alcohol drinking No 1 109(57.9) 461(72.3) 314(36.9) 334(78.2) 398.020 <0.001
Yes 430(22.5) 151(23.7) 211(24.8) 68(15.9)
Unknown 376(19.6) 26(4.1) 325(38.2) 25(5.9)
T stage T1 525(27.4) 176(27.6) 228(26.8) 121(28.3) 74.554 <0.001
T2 733(38.3) 215(33.7) 352(41.4) 166(38.9)
T3 205(10.7) 33(5.2) 112(13.2) 60(14.1)
T4 439(22.9) 208(32.6) 152(17.9) 79(18.5)
Unknown 13(0.7) 6(0.9) 6(0.7) 1(0.2)
N stage N0 1 204(62.9) 410(64.3) 536(63.1) 258(60.4) 242.931 <0.001
N1-3 599(31.3) 121(19.0) 310(36.5) 168(39.3)
Unknown 112(5.9) 107(16.8) 4(0.5) 1(0.2)
M stage M0 1 903(99.4) 633(99.2) 843(99.2) 427(100.0) 3.475 0.176
M1 12(0.6) 5(0.8) 7(0.8) 0(0.0)
AJCC stage I 440(23.0) 151(23.7) 189(22.2) 100(23.4) 272.347 <0.001
II 487(25.4) 146(22.9) 233(27.4) 108(25.3)
III 305(15.9) 36(5.6) 195(22.9) 74(17.3)
IV 563(29.4) 193(30.3) 226(26.6) 144(33.7)
Unknown 120(6.3) 112(17.6) 7(0.8) 1(0.2)

Table 2

Trend and five-year disease-specific survival of patients diagnosed with oral cavity squamous cell carcinoma who underwent different treatment modalities"

Total 1990-1999 2000-2009 2010-2013
n(%) DSS n(%) DSS n(%) DSS n(%) DSS
Variants Total 1 915 0.57 638 0.53 850 0.56 427 0.64
Treatment Surgery 984(51.4) 0.72 242(37.9) 0.66 469(55.2) 0.73 273(63.9) 0.77
RT 27(1.4) 0.55 17(2.7) 0.64 9(1.1) 0.49 1(0.2) -
Chemo 260(13.6) 0.14 68(10.7) 0.08 166(19.5) 0.96 26(6.1) 0.11
S+RT 132(6.9) 0.60 62(9.7) 0.59 32(3.8) 0.56 38(8.9) 0.67
S+Chemo 316(16.5) 0.55 142(22.3) 0.62 136(16.0) 0.54 38(8.9) 0.34
RT+Chemo 89(4.7) 0.26 57(8.9) 0.27 22(2.6) 0.27 10(2.3) 0.22
S+RT+Chemo 107(5.6) 0.42 50(7.8) 0.45 16(1.9) 0.36 41(9.6) 0.41
Surgery Yes 1 539(80.4) 0.66 496(77.7) 0.62 653(76.8) 0.67 390(91.3) 0.69
No 376(19.6) 0.19 142(22.3) 0.20 197(23.2) 0.19 37(8.7) 0.15

Figure 1

Disease-specific survival curves of patients with oral squamous cell carcinoma a: survival curves for disease-specific mortality for 1 915 patients diagnosed with oral cavity squamous cell carcinoma, 1990-2013; b: survival curves for disease-specific mortality for patients diagnosed with oral cavity squamous cell carcinoma in each of the successive eras (P < 0.001); c: survival curves for disease-specific mortality for patients diagnosed with oral cavity squamous cell carcinoma by age (P < 0.001); d: survival curves for disease-specific mortality for patients diagnosed with oral cavity squamous cell carcinoma by gender (P < 0.001); e: survival curves for disease-specific mortality for patients diagnosed with oral cavity squamous cell carcinoma by smoking (P < 0.001); f: survival curves for disease-specific mortality for patients diagnosed with oral cavity squamous cell carcinoma by alcohol drinking (P < 0.001); g: survival curves for disease-specific mortality for patients diagnosed with oral cavity squamous cell carcinoma by AJCC stage (P < 0.001); h: survival curves for disease-specific mortality for patients diagnosed with oral cavity squamous cell carcinoma by initial therapy (P < 0.001); i: survival curves for disease-specific mortality for patients diagnosed with oral cavity squamous cell carcinoma by tumor localization (P < 0.001)"

Table 3

Five-year disease-specific survival of patients diagnosed with squamous cell carcinoma of different subsites in the oral cavity"

Variants Total 1990-1999 2000-2009 2010-2013
n(%) DSS n(%) DSS n(%) DSS n(%) DSS
Total 1 915 0.57 638 0.53 850 0.56 427 0.64
Oral tongue 1 218(63.6) 0.63 414(64.9) 0.59 544(64.0) 0.64 260(60.9) 0.71
Floor of mouth 205(10.7) 0.40 65(10.2) 0.44 87(10.2) 0.35 53(12.4) 0.44
Buccal mucosa 139(7.3) 0.43 41(6.4) 0.35 67(7.9) 0.39 31(7.3) 0.64
Gingiva 222(11.6) 0.44 74(11.6) 0.29 91(10.7) 0.49 57(13.4) 0.57
Retromolar triangle 18(0.9) 0.39 2(0.3) - 11(1.3) 0.35 5(1.2) 0.25
Hard palate 63(3.3) 0.42 18(2.8) 0.57 31(3.7) 0.30 14(3.3) 0.50
Lip 50(2.6) 0.81 24(3.8) 0.71 19(2.2) 0.94 7(1.6) 0.83
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