Oral Cavity Cancer Prognosis Has Improved Over Time

What are the temporal trends demographics, treatment, and prognosis of oral cavity cancer over a 40-year period?

Bottom Line
OCSCC prognosis has improved significantly from the early 1970s to recent years, associated with an increased use of adjuvant therapy and adjuvant chemoradiotherapy in late-stage oral cancer.

Background: The general therapeutic approach to oral cavity squamous cell carcinoma (OCSCC) — surgery followed by adjuvant radiation in cases with high-risk pathologic features or high-stage disease — has not changed. One exception has been the adoption of adjuvant concomitant chemoradiotherapy for certain high-risk pathologic features, but the extent to which quality of life improvements have truly altered OCSCC prognosis nationally over time is not clear.

Study design: Retrospective database analysis of 16,030 adult patients diagnosed with oral cavity cancer and treated surgically between 1973 and 2014.

Setting: National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) 9 registry; data from the National Cancer Database (NCDB).

Synopsis: Patients were about equally likely to present with early- or late-stage disease. Fewer patients present with low-grade tumors, those with intermediate-grade tumors have increased, and those presenting with high-grade malignancies has stayed consistent. The proportion of patients presenting with a primary on the tongue has increased by half; the proportion presenting with a primary on the floor of the mouth has dropped to almost a third of its initial value. For early-stage disease patients, survival has incrementally improved in each decade since 1973. For late-stage disease patients, survival improved slightly up to 2000, with more dramatic improvements since then. Diagnosis from 2011–2014 had less than half the hazard rate of 1973–1980 diagnosis. Adjuvant radiotherapy use has decreased since 2000 for early-stage OCSCC, but increased for adjuvant chemoradiotherapy use for late-stage OCSCC. Although survival for early- and late-stage disease has improved, the difference in survival between the two has widened. Additionally, death associated with older age as well as higher tumor grade has increased in magnitude over time. Between 1981 and 1990, black race was significantly associated with diminished survival, but this association ceased in 2011. Limitations include uncontrolled variables due to lack of data at source and limited follow-up for patients diagnosed in recent years.

Citation: Cheraghlou S, Schettino A, Zogg CK, Judson BL. Changing prognosis of oral cancer: An analysis of survival and treatment between 1973 and 2014. Laryngoscope. Published online ahead of print September 7, 2018. doi: 10.1002/lary. 27315.