Factors affecting the recurrence of early-stage lip cancer

Background : To determine the patterns of recurrence, prognostic factors and treatment outcomes in stage I-II lip cancer. Materials and Methods : A retrospective review was made of the data of 74 patients diagnosed with squamous cell carcinoma (SCC) of the lip between 2000 and 2009. Results : In all, 44 of the patients had stage I disease and 30 had stage II disease. Surgery was performed on the primary tumor in all patients, 15 received adjuvant radiotherapy and 23 underwent elective neck therapy. Recurrence occurred in 23 (31%) of the patients, with a mean time from surgery to relapse of 23 months. The frequency of nodal recurrence increased as tumor stage and depth increased. Adjuvant radiotherapy and neck dissection or elective radiotherapy decreased the risk of recurrence in tumors with depths of over 0.5 cm, with positive or close margins, and with perineural invasion. The median overall survival (OS) was 120 months and the median disease-free survival (DFS) was 83 months. A univariate analysis revealed tumor stage and depth, adjuvant radiotherapy, and neck treatment (lymphatic dissection + nodal irradiation) to affect DFS, while a multivariate analysis showed that elective neck radiotherapy improved DFS. Conclusion : Greater tumor stage and depth increase the risk of nodal recurrence in early-stage lip cancer, although the frequency of recurrence is decreased in such patients if treated with elective neck dissection and/or postoperative radiotherapy.