Pub Date : 2025-12-01Epub Date: 2025-10-29DOI: 10.1016/j.oraloncology.2025.107764
Beatriz Bertin , Luiz Paulo Kowalski , Leandro Luongo Matos
Treatment of head and neck cancer in older patients is particularly complex, as they are more prone to side effects and treatment-related toxicity due to age-related physiological changes. Nevertheless, they should still receive care based on the best available standards and protocols, since alternative approaches may increase the risk of treatment failure and mortality. The core issue lies in the lack of evidence-based protocols tailored to the specific needs of older patients, as most clinical trials seam to focus on younger populations. The objective of this study was to determine the rate of patients over 65 years of age included in clinical trials of treatments for head and neck cancer. In this context, the study aims to shed light on the proportion of clinical evidence that can be safely extrapolated to the treatment of older patients with head and neck cancer. To achieve this, we analyzed the age distribution of patients enrolled in clinical trials cited by the National Comprehensive Cancer Network (NCCN) in the NCCN Guidelines Version 2.2025: Head and Neck Cancers. Less than one-fourth of patients enrolled in the NCCN-referenced clinical trials were over 65 years of age, reinforcing concerns about the applicability of current protocols to this population. To address this gap, the most effective strategy is to promote the generation and dissemination of evidence-based data that actively includes older adults worldwide.
{"title":"The low evidence to treat elderly patients with head and neck cancer","authors":"Beatriz Bertin , Luiz Paulo Kowalski , Leandro Luongo Matos","doi":"10.1016/j.oraloncology.2025.107764","DOIUrl":"10.1016/j.oraloncology.2025.107764","url":null,"abstract":"<div><div>Treatment of head and neck cancer in older patients is particularly complex, as they are more prone to side effects and treatment-related toxicity due to age-related physiological changes. Nevertheless, they should still receive care based on the best available standards and protocols, since alternative approaches may increase the risk of treatment failure and mortality. The core issue lies in the lack of evidence-based protocols tailored to the specific needs of older patients, as most clinical trials seam to focus on younger populations. The objective of this study was to determine the rate of patients over 65 years of age included in clinical trials of treatments for head and neck cancer. In this context, the study aims to shed light on the proportion of clinical evidence that can be safely extrapolated to the treatment of older patients with head and neck cancer. To achieve this, we analyzed the age distribution of patients enrolled in clinical trials cited by the National Comprehensive Cancer Network (NCCN) in the NCCN Guidelines Version 2.2025: Head and Neck Cancers. Less than one-fourth of patients enrolled in the NCCN-referenced clinical trials were over 65 years of age, reinforcing concerns about the applicability of current protocols to this population. To address this gap, the most effective strategy is to promote the generation and dissemination of evidence-based data that actively includes older adults worldwide.</div></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"171 ","pages":"Article 107764"},"PeriodicalIF":3.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145374455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-29DOI: 10.1016/j.oraloncology.2025.107749
Nengjun Xiang , Wentao Li
{"title":"Re: “Patterns of care in de‑novo oligo‑metastatic and oligo‑recurrent head and neck cancers: A HNCIG survey” (Oral oncology)","authors":"Nengjun Xiang , Wentao Li","doi":"10.1016/j.oraloncology.2025.107749","DOIUrl":"10.1016/j.oraloncology.2025.107749","url":null,"abstract":"","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"171 ","pages":"Article 107749"},"PeriodicalIF":3.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145374456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-11-22DOI: 10.1016/j.oraloncology.2025.107794
Revadhi C Chelvarajah , Shao Hui Huang , Jie Su , Maru Gete , Jolie Ringash , Ian Witterick , John de Almeida , Eric Monteiro , Ralph Gilbert , Anna Spreafico , John Waldron , Brian O’Sullivan , Ali Hosni , Scott Bratman , B.C.John Cho , Andrew Hope , John Kim , Andrew McPartlin , C.Jillian Tsai , Li Tong , Ezra Hahn
Purpose
We report our experience with resectable sinonasal squamous cell carcinoma (SNSCC) treated with pre-operative (preop-RT) or postoperative radiotherapy (postop-RT), focusing on oncologic outcomes and patient selection.
Material
All SNSCC treated with preop-RT or postop-RT from 2005 to 2021 were included. Clinical characteristics and outcomes were compared between cohorts. Actuarial rates of overall survival (OS), locoregional control (LRC), distant control (DC), and late toxicity were estimated.
Results
Among 71 eligible patients, 25 received preop-RT and 46 postop-RT. Preop-RT cohort comprised more ethmoid primary (32 % vs 0 %, p < 0.001) and T3-T4 diseases (versus T1-2) (96 % vs 65 %, p < 0.04), with larger tumors (mean 62 vs 49 cm3, p = 0.02). Reasons for preop-RT included reduced dose and volume of critical organs (n = 16, 64 %), avoidance of orbital exenteration (n = 2, 8 %), maximizing likelihood of achieving clear resection margins (n = 5, 20 %) and other (n = 2, 8 %). Eight (32 %) preop-RT patients had a pathological complete response. Positive resection margin was identified less frequently in the preop-RT (n = 2) vs postop-RT (n = 23) cohorts (8 % vs 50 %, p < 0.001). Five (20 %) patients in the preop-RT cohort had local recurrence (1 residual, 4 recurrence) vs 16 (35 %) in the postop-RT cohort. Five-year actuarial rates of LRC (78 % vs 64 %, p = 0.107), DC (92 % vs 81 %, p = 0.524), OS (76 % vs 65 %, p = 0.912), and grade 3–4 late toxicity (18 % vs 12 %, p = 0.394) were similar between preop-RT and postop-RT cohorts, respectively.
Conclusion
Preop-RT achieved similar oncologic outcomes to postop-RT despite higher T-categories, and is a reasonable option for select patients with locally advanced SNSCC in a collaborative multidisciplinary, high-volume setting.
目的报告可切除鼻窦鳞状细胞癌(SNSCC)术前(preop-RT)或术后放疗(post - rt)治疗的经验,重点讨论肿瘤预后和患者选择。材料纳入2005 - 2021年所有接受术前或术后放疗的SNSCC。比较两组患者的临床特征和结局。估计总生存(OS)、局部区域控制(LRC)、远处控制(DC)和晚期毒性的精算率。结果71例符合条件的患者中,25例接受术前放疗,46例接受术后放疗。术前放疗队列包括更多的筛原发疾病(32% vs 0%, p < 0.001)和T3-T4疾病(T1-2) (96% vs 65%, p < 0.04),肿瘤较大(平均62 vs 49 cm3, p = 0.02)。术前放疗的原因包括减少了关键器官的剂量和体积(n = 16, 64%),避免了眼眶切除(n = 2.8 %),最大限度地实现了切除边缘的可能性(n = 5, 20%)和其他(n = 2.8 %)。8例(32%)放疗前患者病理完全缓解。在术前rt组(n = 2)和术后rt组(n = 23)中,阳性切除边缘的识别频率较低(8%对50%,p < 0.001)。放疗前队列中有5例(20%)患者局部复发(1例残留,4例复发),而放疗后队列中有16例(35%)。LRC (78% vs 64%, p = 0.107)、DC (92% vs 81%, p = 0.524)、OS (76% vs 65%, p = 0.912)和3-4级晚期毒性(18% vs 12%, p = 0.394)的5年精算率分别在放疗前和放疗后队列中相似。尽管t分类更高,但preop - rt与stop- rt的肿瘤预后相似,对于局部晚期SNSCC患者来说,在多学科合作、高容量的环境下,preop - rt是一种合理的选择。
{"title":"Outcomes and characteristics of patients receiving pre-operative versus post-operative radiotherapy for sinonasal squamous cell carcinoma","authors":"Revadhi C Chelvarajah , Shao Hui Huang , Jie Su , Maru Gete , Jolie Ringash , Ian Witterick , John de Almeida , Eric Monteiro , Ralph Gilbert , Anna Spreafico , John Waldron , Brian O’Sullivan , Ali Hosni , Scott Bratman , B.C.John Cho , Andrew Hope , John Kim , Andrew McPartlin , C.Jillian Tsai , Li Tong , Ezra Hahn","doi":"10.1016/j.oraloncology.2025.107794","DOIUrl":"10.1016/j.oraloncology.2025.107794","url":null,"abstract":"<div><h3>Purpose</h3><div>We report our experience with resectable sinonasal squamous cell carcinoma (SNSCC) treated with pre-operative (preop-RT) or postoperative radiotherapy (postop-RT), focusing on oncologic outcomes and patient selection.</div></div><div><h3>Material</h3><div>All SNSCC treated with preop-RT or postop-RT from 2005 to 2021 were included. Clinical characteristics and outcomes were compared between cohorts. Actuarial rates of overall survival (OS), locoregional control (LRC), distant control (DC), and late toxicity were estimated.</div></div><div><h3>Results</h3><div>Among 71 eligible patients, 25 received preop-RT and 46 postop-RT. Preop-RT cohort comprised more ethmoid primary (32 % vs 0 %, p < 0.001) and T3-T4 diseases (versus T1-2) (96 % vs 65 %, p < 0.04), with larger tumors (mean 62 vs 49 cm<sup>3</sup>, p = 0.02). Reasons for preop-RT included reduced dose and volume of critical organs (n = 16, 64 %), avoidance of orbital exenteration (n = 2, 8 %), maximizing likelihood of achieving clear resection margins (n = 5, 20 %) and other (n = 2, 8 %). Eight (32 %) preop-RT patients had a pathological complete response. Positive resection margin was identified less frequently in the preop-RT (n = 2) vs postop-RT (n = 23) cohorts (8 % vs 50 %, p < 0.001). Five (20 %) patients in the preop-RT cohort had local recurrence (1 residual, 4 recurrence) vs 16 (35 %) in the postop-RT cohort. Five-year actuarial rates of LRC (78 % vs 64 %, p = 0.107), DC (92 % vs 81 %, p = 0.524), OS (76 % vs 65 %, p = 0.912), and grade 3–4 late toxicity (18 % vs 12 %, p = 0.394) were similar between preop-RT and postop-RT cohorts, respectively.</div></div><div><h3>Conclusion</h3><div>Preop-RT achieved similar oncologic outcomes to postop-RT despite higher T-categories, and is a reasonable option for select patients with locally advanced SNSCC in a collaborative multidisciplinary, high-volume setting.</div></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"171 ","pages":"Article 107794"},"PeriodicalIF":3.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145569571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-11-01DOI: 10.1016/j.oraloncology.2025.107767
Agnes Q Zhu , Claire E Cassianni , Travis Haller , Thomas J. O’Byrne , Pablo Ochoa , Tissiana Vallecillo , Andrew Pumford , Felicia Olawuni , Eric J Moore , Daniel L Price , Kendall K Tasche , Linda X Yin , Daniel J Ma , Scott C Lester , Mauricio Gamez , Michelle A Neben Wittich , Katharine A Price , Kathryn M Van Abel , David M Routman
Introduction
There is a lack of data regarding the appropriate surveillance of HPV(+)OPSCC. Our study aims to determine the sensitivity of patient symptoms, physical exam findings, and imaging in identifying recurrence and disease progression.
Methods
Mayo Clinic IRB (22–000684) approval was obtained, and the departmental REDCap database was queried to identify all HPV(+)OPSCC patients from 01/01/2006 to 12/31/2021 at our tertiary care center. Surgically treated patients with pathologic specimens positive for HPV (confirmed with in-situ hybridization (ISH) and/or p16 immuno-histochemistry) without evidence of distant metastatic disease at diagnosis were included. Sensitivity, specificity, PPV, and NPV of patient symptoms, physical exam findings, and imaging for disease progression were assessed both overall and at each time point.
Results
142/1142 patients experienced disease progression. 70% of patients with disease progression were detected within the first two years of surveillance. 79 patients with disease progression were detected via routine surveillance imaging, 34 via patient-reported symptoms, and 5 via physical exam.
Routine surveillance imaging was the most sensitive method of detection for locoregional recurrence (sensitivity 92.3%, PPV 6.5%, NPV 42.9%) and distant metastasis (sensitivity 100%, PPV 6.7%, NPV 100.0%). Patient symptoms in aggregate had a 73.1% sensitivity for detecting locoregional recurrence (PPV 8.7%, NPV 95.4%); however no individual symptom had a sensitivity over 30%. Physical exam findings were the least sensitive method of detection.
Conclusion
Our findings demonstrate that the majority of recurrences are detected within the first two years of surveillance. Routine surveillance imaging is the most sensitive modality for detecting disease progression as compared to patient symptoms or physical exam findings. Additional studies integrating newer technologies, such as ctHPVDNA. into surveillance are needed.
{"title":"Sensitivity of post-treatment surveillance in detecting recurrence and metastasis in surgically treated HPV-positive oropharyngeal squamous cell carcinoma patients","authors":"Agnes Q Zhu , Claire E Cassianni , Travis Haller , Thomas J. O’Byrne , Pablo Ochoa , Tissiana Vallecillo , Andrew Pumford , Felicia Olawuni , Eric J Moore , Daniel L Price , Kendall K Tasche , Linda X Yin , Daniel J Ma , Scott C Lester , Mauricio Gamez , Michelle A Neben Wittich , Katharine A Price , Kathryn M Van Abel , David M Routman","doi":"10.1016/j.oraloncology.2025.107767","DOIUrl":"10.1016/j.oraloncology.2025.107767","url":null,"abstract":"<div><h3>Introduction</h3><div>There is a lack of data regarding the appropriate surveillance of HPV(+)OPSCC. Our study aims to determine the sensitivity of patient symptoms, physical exam findings, and imaging in identifying recurrence and disease progression.</div></div><div><h3>Methods</h3><div>Mayo Clinic IRB (22–000684) approval was obtained, and the departmental REDCap database was queried to identify all HPV(+)OPSCC patients from 01/01/2006 to 12/31/2021 at our tertiary care center. Surgically treated patients with pathologic specimens positive for HPV (confirmed with in-situ hybridization (ISH) and/or p16 immuno-histochemistry) without evidence of distant metastatic disease at diagnosis were included.<!--> <!-->Sensitivity, specificity, PPV, and NPV of patient symptoms, physical exam findings, and imaging for disease progression were assessed both overall and at each time point.</div></div><div><h3>Results</h3><div>142/1142 patients experienced disease progression. 70% of patients with disease progression were detected within the first two years of surveillance. 79 patients with disease progression were detected via routine surveillance imaging, 34 via patient-reported symptoms, and 5 via physical exam.</div><div>Routine surveillance imaging was the most sensitive method of detection for locoregional recurrence (sensitivity 92.3%, PPV 6.5%, NPV 42.9%) and distant metastasis (sensitivity 100%, PPV 6.7%, NPV 100.0%). Patient symptoms in aggregate had a 73.1% sensitivity for detecting locoregional recurrence (PPV 8.7%, NPV 95.4%); however no individual symptom had a sensitivity over 30%. Physical exam findings were the least sensitive method of detection.</div></div><div><h3>Conclusion</h3><div>Our findings demonstrate that the majority of recurrences are detected within the first two years of surveillance. Routine surveillance imaging is the most sensitive modality for detecting disease progression as compared to patient symptoms or physical exam findings. Additional studies integrating newer technologies, such as ctHPVDNA. into surveillance are needed.</div></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"171 ","pages":"Article 107767"},"PeriodicalIF":3.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-11-04DOI: 10.1016/j.oraloncology.2025.107766
Victorine Maso , Jerome R Lechien , Isabelle Gengler , Carlos Chiesa-Estomba , Johannes J. Fagan , Sheng-Po Hao , Luiz P. Kowalski , Bernard Lyons , Emmanuel Babin , Mohamad Yunus Mohd Razif , Hani Z. Marzouki , Angel Ramos Macias , Hector E. Ruiz , Antonino Maniaci , Bernard Fraysse , Matthew White , Justin Michel , Nicolas Fakhry
Objectives
To evaluate worldwide medical practices of otolaryngology centers in managing patients with Head And Neck Cancer (HNC)
Materials and Methods
We performed an online survey sent to otorhinolaryngologists worldwide via the IFOS between February and March 2024. The following aspects were evaluated: personal characteristics, diagnostics modalities, treatments, global management, cultural specificities and clinical cases. We compared results between centers in different geographical areas: Europe, North America, South and Central America, Asia, Africa Sub-Saharan, Oceania, and Middle East & North Africa (MENA).
Results
A total of 566 otorhinolaryngologists from 457 centers in 101 countries responded. International guideline adherence was lower in North America (45.5 %) than globally (74.5 %; p = 0.005). HPV/p16 testing was less common in Africa (28.9 %) and MENA (60.8 %) versus other regions (92.8 %; p < 0.001). PD-L1 testing was frequent in Europe (84.6 %) but rare in Africa (5.3 %; p < 0.001). Multidisciplinary Tumor Boards were systematic in Europe (88.9 %) and Oceania (87.5 %) but used selectively elsewhere. Intensity-modulated radiation therapy use was lower in Africa (28.9 %) and MENA (64.6 %; p < 0.001). A total of 95.7 % of centers had access to chemotherapy, with no differences between regions (p = 0.236). African centers cited cost as a major barrier (79.5 % vs. 33.8 %; p < 0.001). MRI and PET/CT access was significantly lower in Africa (51.2 % and 5 %), Central/South America (79.5 % and 47.7 %), and MENA (80.9 % and 43.8 %) than other regions (89.5 % and 73.2 %; p < 0.001).
Conclusion
The management of HNC exhibits significant variability worldwide. International guidelines should consider the economic, cultural, and geographic specificities of each continent to ensure context-sensitive care.
{"title":"Management of head and neck cancer around the world: an international survey by the world ear, nose, and throat federation","authors":"Victorine Maso , Jerome R Lechien , Isabelle Gengler , Carlos Chiesa-Estomba , Johannes J. Fagan , Sheng-Po Hao , Luiz P. Kowalski , Bernard Lyons , Emmanuel Babin , Mohamad Yunus Mohd Razif , Hani Z. Marzouki , Angel Ramos Macias , Hector E. Ruiz , Antonino Maniaci , Bernard Fraysse , Matthew White , Justin Michel , Nicolas Fakhry","doi":"10.1016/j.oraloncology.2025.107766","DOIUrl":"10.1016/j.oraloncology.2025.107766","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate worldwide medical practices of otolaryngology centers in managing patients with Head And Neck Cancer (HNC)</div></div><div><h3>Materials and Methods</h3><div>We performed an online survey sent to otorhinolaryngologists worldwide via the IFOS between February and March 2024. The following aspects were evaluated: personal characteristics, diagnostics modalities, treatments, global management, cultural specificities and clinical cases. We compared results between centers in different geographical areas: Europe, North America, South and Central America, Asia, Africa Sub-Saharan, Oceania, and Middle East & North Africa (MENA).</div></div><div><h3>Results</h3><div>A total of 566 otorhinolaryngologists from 457 centers in 101 countries responded. International guideline adherence was lower in North America (45.5 %) than globally (74.5 %; p = 0.005). HPV/p16 testing was less common in Africa (28.9 %) and MENA (60.8 %) versus other regions (92.8 %; p < 0.001). PD-L1 testing was frequent in Europe (84.6 %) but rare in Africa (5.3 %; p < 0.001). Multidisciplinary Tumor Boards were systematic in Europe (88.9 %) and Oceania (87.5 %) but used selectively elsewhere. Intensity-modulated radiation therapy use was lower in Africa (28.9 %) and MENA (64.6 %; p < 0.001). A total of 95.7 % of centers had access to chemotherapy, with no differences between regions (p = 0.236). African centers cited cost as a major barrier (79.5 % vs. 33.8 %; p < 0.001). MRI and PET/CT access was significantly lower in Africa (51.2 % and 5 %), Central/South America (79.5 % and 47.7 %), and MENA (80.9 % and 43.8 %) than other regions (89.5 % and 73.2 %; p < 0.001).</div></div><div><h3>Conclusion</h3><div>The management of HNC exhibits significant variability worldwide. International guidelines should consider the economic, cultural, and geographic specificities of each continent to ensure context-sensitive care.</div></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"171 ","pages":"Article 107766"},"PeriodicalIF":3.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145445633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In oral cavity cancers, tumors invading the bone marrow of the mandible or maxilla have traditionally been classified as T4a in the TNM staging system. This study evaluated the impact of bone invasion on T classification and survival in patients with squamous cell carcinoma of the oral cavity.
Materials and methods
We retrospectively reviewed and restaged 2,143 patients treated between 2001 and 2019. Bone invasion was categorized as no bone invasion, non-mandibular canal (MC) bone marrow invasion, or MC invasion. Disease-specific survival (DSS) was the primary endpoint. Prognostic performance was assessed using Kaplan–Meier analysis and Cox proportional hazards models. Discriminative ability was evaluated with Harrell’s concordance index (C-index) and calibration analysis.
Results
Among 505 T4a tumors, 271 (53.7%) were classified as T4a solely due to bone marrow invasion, and their survival outcomes were comparable to those of T3 tumors. In multivariate analysis, MC invasion was independently associated with worse DSS, whereas non-MC bone marrow invasion was not. Based on these findings, we developed two revised versions of the MC-T classification for oral tumors, replacing bone marrow invasion with MC invasion as a T4a criterion in the 8th edition UICC/AJCC T classification. Both MC-T classifications showed superior prognostic discrimination, with higher C-indices than the original system.
Conclusions
Patients with T4a oral tumors classified solely by bone marrow invasion had survival outcomes similar to those with T3 tumors. The proposed MC-T classification improves prognostic accuracy by more effectively stratifying T4a tumors.
背景与目的:在口腔癌中,侵袭下颌骨或上颌骨髓的肿瘤在TNM分期系统中传统上被归类为T4a。本研究评估骨浸润对口腔鳞状细胞癌患者T分类和生存的影响。材料和方法:我们对2001年至2019年期间接受治疗的2143例患者进行了回顾性研究和再治疗。骨侵犯分为无骨侵犯、非下颌管(MC)骨髓侵犯和下颌管侵犯。疾病特异性生存(DSS)是主要终点。采用Kaplan-Meier分析和Cox比例风险模型评估预后。采用Harrell’s concordance index (C-index)和校正分析评价辨别力。结果505例T4a肿瘤中有271例(53.7%)仅因骨髓侵袭被归为T4a,其生存结局与T3肿瘤相当。在多变量分析中,MC侵袭与DSS恶化独立相关,而非MC骨髓侵袭与DSS恶化无关。基于这些发现,我们制定了两个修订版本的口腔肿瘤MC-T分类,在第8版UICC/AJCC T分类中以MC侵袭取代骨髓侵袭作为T4a标准。两种MC-T分类均具有较好的预后判别能力,其c指数均高于原分类系统。结论:单纯以骨髓侵袭分类的T4a口腔肿瘤患者的生存结局与T3肿瘤相似。提出的MC-T分类通过更有效地对T4a肿瘤进行分层,提高了预后准确性。
{"title":"T4a classification for oral cancer using mandibular canal invasion instead of bone marrow invasion in the TNM staging system","authors":"Masaya Okura , Nobuhiro Yamakawa , Mitsunobu Otsuru , Takumi Hasegawa , Yusuke Yokota , Shin Rin , Hironori Sakai , Shin-ichi Yamada , Eiji Hirai , Yuichi Ashikaga , Kozo Yamamoto , Michihiro Ueda , Tadaaki Kirita , Masahiro Umeda , Masaya Akashi , Hiroshi Kurita , Yoichi Ohiro , Tomofumi Naruse , Souichi Yanamoto , Japan Oral Oncology Group JOOG","doi":"10.1016/j.oraloncology.2025.107771","DOIUrl":"10.1016/j.oraloncology.2025.107771","url":null,"abstract":"<div><h3>Background and purpose</h3><div>In oral cavity cancers, tumors invading the bone marrow of the mandible or maxilla have traditionally been classified as T4a in the TNM staging system. This study evaluated the impact of bone invasion on T classification and survival in patients with squamous cell carcinoma of the oral cavity.</div></div><div><h3>Materials and methods</h3><div>We retrospectively reviewed and restaged 2,143 patients treated between 2001 and 2019. Bone invasion was categorized as no bone invasion, non-mandibular canal (MC) bone marrow invasion, or MC invasion. Disease-specific survival (DSS) was the primary endpoint. Prognostic performance was assessed using Kaplan–Meier analysis and Cox proportional hazards models. Discriminative ability was evaluated with Harrell’s concordance index (C-index) and calibration analysis.</div></div><div><h3>Results</h3><div>Among 505 T4a tumors, 271 (53.7%) were classified as T4a solely due to bone marrow invasion, and their survival outcomes were comparable to those of T3 tumors. In multivariate analysis, MC invasion was independently associated with worse DSS, whereas non-MC bone marrow invasion was not. Based on these findings, we developed two revised versions of the MC-T classification for oral tumors, replacing bone marrow invasion with MC invasion as a T4a criterion in the 8th edition UICC/AJCC T classification. Both MC-T classifications showed superior prognostic discrimination, with higher C-indices than the original system.</div></div><div><h3>Conclusions</h3><div>Patients with T4a oral tumors classified solely by bone marrow invasion had survival outcomes similar to those with T3 tumors. The proposed MC-T classification improves prognostic accuracy by more effectively stratifying T4a tumors.</div></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"171 ","pages":"Article 107771"},"PeriodicalIF":3.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145506328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The standard treatment for locally advanced oral squamous cell carcinoma (OSCC) involves radical surgery followed by adjuvant therapy, often resulting in significant functional impairment. Neoadjuvant immunochemotherapy (NICT) has emerged as a promising strategy to facilitate surgical de-escalation while preserving oncologic outcomes. This study evaluates the feasibility of response-adapted surgery (RAS) following NICT in OSCC.
Methods
In this retrospective analysis, 152 patients with previously untreated OSCC received NICT followed by either RAS (n = 66) or traditional surgery (TS, n = 86). RAS was tailored to post-NICT tumor regression, while TS adhered to pretreatment tumor extent. Primary endpoints were 3-year event-free survival (EFS) and overall survival (OS). Secondary endpoints included quality of life (QoL, assessed via EORTC QLQ-HN35) and perioperative complications.
Results
The RAS and TS cohorts exhibited comparable 3-year EFS (78.8 % vs. 79.1 %, p = 0.944) and OS (90.9 % vs. 91.9 %, p = 0.826). RAS significantly reduced the need for mandibulectomy (16.7 % vs. 41.9 %, p = 0.009) and free flap reconstruction (15.2 % vs. 48.8 %, p = 0.018), with fewer major complications (4.5 % vs. 11.6 %, p = 0.048). QoL metrics favored RAS, particularly in swallowing (15 ± 3.8 vs. 28 ± 5.5, p < 0.001) and speech (14 ± 3.9 vs. 25 ± 5.2, p < 0.001) at 12 months. Major pathologic response and PD-L1 CPS > 20 were associated with improved survival.
Conclusions
RAS after NICT achieves oncologic outcomes equivalent to TS while significantly reducing treatment-related morbidity and improving functional recovery. These findings support RAS as a viable de-escalation strategy for OSCC, aligning with the goals of precision oncology. Prospective trials are needed to validate long-term efficacy and refine patient selection criteria.
{"title":"Response-adapted surgery after neoadjuvant immunochemotherapy in oral squamous cell carcinoma","authors":"Qigen Fang , Junhui Yuan , Xu Zhang , Tao Huang , Lanwei Guo","doi":"10.1016/j.oraloncology.2025.107769","DOIUrl":"10.1016/j.oraloncology.2025.107769","url":null,"abstract":"<div><h3>Objective</h3><div>The standard treatment for locally advanced oral squamous cell carcinoma (OSCC) involves radical surgery followed by adjuvant therapy, often resulting in significant functional impairment. Neoadjuvant immunochemotherapy (NICT) has emerged as a promising strategy to facilitate surgical de-escalation while preserving oncologic outcomes. This study evaluates the feasibility of response-adapted surgery (RAS) following NICT in OSCC.</div></div><div><h3>Methods</h3><div>In this retrospective analysis, 152 patients with previously untreated OSCC received NICT followed by either RAS (n = 66) or traditional surgery (TS, n = 86). RAS was tailored to post-NICT tumor regression, while TS adhered to pretreatment tumor extent. Primary endpoints were 3-year event-free survival (EFS) and overall survival (OS). Secondary endpoints included quality of life (QoL, assessed via EORTC QLQ-HN35) and perioperative complications.</div></div><div><h3>Results</h3><div>The RAS and TS cohorts exhibited comparable 3-year EFS (78.8 % vs. 79.1 %, p = 0.944) and OS (90.9 % vs. 91.9 %, p = 0.826). RAS significantly reduced the need for mandibulectomy (16.7 % vs. 41.9 %, p = 0.009) and free flap reconstruction (15.2 % vs. 48.8 %, p = 0.018), with fewer major complications (4.5 % vs. 11.6 %, p = 0.048). QoL metrics favored RAS, particularly in swallowing (15 ± 3.8 vs. 28 ± 5.5, p < 0.001) and speech (14 ± 3.9 vs. 25 ± 5.2, p < 0.001) at 12 months. Major pathologic response and PD-L1 CPS > 20 were associated with improved survival.</div></div><div><h3>Conclusions</h3><div>RAS after NICT achieves oncologic outcomes equivalent to TS while significantly reducing treatment-related morbidity and improving functional recovery. These findings support RAS as a viable de-escalation strategy for OSCC, aligning with the goals of precision oncology. Prospective trials are needed to validate long-term efficacy and refine patient selection criteria.</div></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"171 ","pages":"Article 107769"},"PeriodicalIF":3.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145445656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}