Is Dental Specialty Referral Associated With Earlier Presentation of Oral Cavity Squamous Cell Carcinoma?

Background

Oral cavity squamous cell carcinoma (OSCC) may mimic other more common odontogenic processes such as infection, trauma, and benign pathology. Delays in diagnosis and treatment are known to result in poorer survival outcomes.

Purpose

The study purpose was to measure the association between referral type and OSCC stage at time of presentation.

Study Design, Setting, Sample

This was a retrospective cohort study composed of newly diagnosed OSCC patients treated with surgical resection from 2014 to 2023 at Roswell Park Comprehensive Cancer Center. Patients who presented with self-referrals or had surgical treatment outside of Roswell Park Comprehensive Cancer Center were excluded.

Predictor Variable

The primary predictor was referral source (dental vs medical specialty).

Main Outcome Variable

The primary outcome was pathological T stage (pT stage). The secondary outcome was overall survival (OS).

Covariates

Covariates included demographic data and cancer-related variables (symptomatology, subsite, and risk factors).

Analyses

A multivariate logistical regression model for pT stage was constructed using all significant covariates as well as preoperative patient and tumor characteristics. For OS, Kaplan-Meier survival curves were constructed and compared with the log-rank test. A P < .05 was considered statistically significant.

Results

A total of 215 subjects were included in the study sample. The majority were referred by a dental provider (n = 132, 62.3%). Dental referrals presented with significantly earlier T stage disease (RR_pT3/T4 0.65, P < .01) and had lower rates of cervical nodal positivity (RR_pN1-N3 0.62, P = .01). Dental referral independently increased the odds of early pT stage presentation (odds ratio 5.10, P < .01) after controlling for age, sex, oral pain symptoms, social history (smoking and drinking), head neck cancer history, and tumor subsite. Dental referrals had significantly improved OS (P = .03) and were also associated with lower rates of oral pain symptoms (RR_{oral pain} 0.80, P = .02), lymphovascular invasion (RR_LVI 0.50; P = .04), and perineural invasion (RR_PNI 0.63, P = .04).

Conclusions and Relevance

Among subjects with similar risk factors, those referred from dental providers were found to have earlier stage disease. Unfortunately, over half of dental referrals still presented with pain symptoms and more than a third presented with locally advanced disease. Dental providers appear to be positioned to detect earlier OSCC; however, there is room for improvement.