JAMA Otol Logo Orlando 2013 AHNS Meeting Location
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American Head & Neck Society
Annual Meeting, April 10-11, 2013
JW Marriott Grande Lakes
Orlando, Florida

During the
Combined Otolaryngology Spring Meeting
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PROGNOSTIC SIGNIFICANCE OF IMMUNE COMPROMISE AND HISTOLOGIC RISK FACTORS FOR LOCAL CONTROL AND SURVIVAL IN TLM-TREATED ORAL CAVITY SQUAMOUS CELL CARCINOMA

Presentation: S010
Topic: Clinical - Outcomes Research
Type: Oral Presentation
Date: Wednesday, April 10, 2013
Session: 04:00 PM - 05:00 PM Robotics
Authors: Parul Sinha, MBBS, MS, Mitra Mehrad, MD, Rebecca D Chernock, MD, James S Lewis Jr, MD, Samir K El-Mofty, DMD, PhD, Brian Nussenbaum, MD, Bruce H Haughey, MBChB, FACS, FRACS
Institution(s): Washington University School of Medicine

Background:Oral cavity squamous cell carcinoma (OCSCC) remains an aggressive disease with substantial mortality. Local recurrences portend a bad outcome despite the excellent surgical margin control achieved with transoral laser microsurgery (TLM). Appreciable local recurrence (LR) rates observed in margin-negative, TLM-treated, OCSCC patients necessitate investigation of new reliable prognosticators for local control. Systemic factors, such as immune compromise need to be considered. Histological factors, such as indexed in the Brandwein-Gensler Risk Model/Score (BGS), have also been proposed for both prediction of LR and overall survival (OS). BGS parameters include worst pattern of invasion (WPOI), perineural invasion (PNI) and tumor/host interface lymphocytic infiltrate (LI). The generalizability of this model needs to be further confirmed: it has not been studied in OCSCC patients treated with TLM.

Objective:The objective of our study is to identify prognosticators for local control and survival in OCSCC patients treated by TLM± neck dissection± adjuvant therapy. In so doing, we also assess the feasibility of BGS in this cohort.

Methods:Analysis of prospectively assembled TLM-treated OCSCC patients from 1995-2010 was performed. Patients with intrinsic, iatrogenic or chronic conditions causing immunodeficiency were considered immune compromised. Local, regional and systemic disease control was recorded. Kaplan-Meier survival estimates were computed. Cox regression analyses were performed to identify variables that were independently prognostic for local control(LC), disease-specific survival (DSS), and OS.

Results: Of 95 OCSCC patients meeting criteria of minimum 24 months follow-up, BGS could be assigned to the 60 patients who comprise the study cohort (Low-BGS=28;High-BGS=32). T-stage was distributed as 27T1, 16T2, 6T3 and 11T4 (AJCC-stage I/II:47%, III/IV:52%). Median follow-up was 45.5 months. Four patients had positive margins at initial resection; only 1 of 4 had tumor on re-resection, thus yielding actual negative margins in 59/60 (98%) patients. Immune compromise was found in 11 (18%) patients. Adjuvant therapy was administered in 27%. Recurrences occurred in 25 patients (11 local, 14 regional and 9 distant), with more than one site in 8 patients. In multivariate analyses, immune compromise was the strongest predictor for LC, DSS and OS. T-stage was prognostic for DSS and OS, but not LC. High- versus low-BGS was significantly associated with higher local recurrences (82%vs.18%) and distant metastases (89%vs.11%), but was prognostic only for OS. Cox analysis could not be performed to predict DSS for high- vs. low-BGS due to no disease-related death in the latter. In the high-BGS group, 2-year LC for patients receiving adjuvant therapy versus none was 80% versus 69% (log rank=0.44). Of the BGS parameters, WPOI and PNI of larger nerves (>1mm) were independent prognosticators of LC, DSS and OS but LI was not.

Conclusions:We identified immune compromise as the most significant independent predictor of local control and survival in OCSCC treated with TLM to negative margins. We also demonstrate the feasibility of BGS risk assessment in this group. High-BGS was associated with recurrences and OS. Larger studies will be necessary to determine the adjuvant therapy-determining utility of BGS. Strategies that maintain or restore tumor-specific immune responses in immunocompromised OCSCC hosts need to be developed and applied.

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