Prognostic value of site-specific metastases in oral cavity and oropharyngeal cancer survival

Presentation: C133
Topic: Survivorship
Type: Poster
Date: Thursday, April 19, 2018
Session: 9:00 AM - 7:00 PM
Authors: Monica C Azmy, BS, Aparna Govindan, BA, Nirali M Patel, BA, Eveylene Kalyoussef, MD, FACS
Institution(s): Rutgers New Jersey Medical School

Objective: To evaluate the prognostic value of site-specific metastases in patients with metastatic oral cavity and oropharyngeal squamous cell carcinoma.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database was queried for 809 cases of metastatic oral cavity and oropharyngeal squamous cell carcinoma (SCC) diagnosed between 2010-2013. Presentation and prognostic outcomes according to the site of metastasis were recorded and classified as metastases to lung, liver, bone, brain, multiple sites, or other. Kaplan-Meier analysis and log-rank testing was used for survival comparisons. Cox regression analyses were performed for multivariate analyses of 5-year disease specific survival (DSS) based on site of metastases.

Results: Among the 809 patients with Stage IVC SCC of the oral cavity and oropharynx, 116 had metastases isolated to the bone, 17 to the brain, 31 to the liver, 287 to the lung, and 129 patients had metastases to multiple sites. Another 229 patients had metastases of another unknown site. On univariate analysis, metastasis to the bone, liver, lung, and multiple sites was significantly associated with 5-year DSS (p= 0.002). Isolated metastases to the brain was not significantly associated with a change in 5-year DSS. Five-year DSS was 33.6% in patients with metastases to unknown site, 21.4% in bone, 37.5% in liver, 25.7% in lung, and 26.4% in multiple sites (Figure 1). On multivariate analyses, age greater than 65 [Hazard ratio (HR) 1.22; 95% CI 1.01-1.48, p= 0.035] and site of metastases to bone, lung, and multiple sites [HR 1.43; 95% CI 1.05-1.93, HR 1.48; 95% CI 1.16-1.89, HR 1.67; 95% CI 1.24-2.23, p= 0.009] were significantly correlated with decreased 5-year DSS.

Conclusion: While metastatic disease serves as a poor prognostic factor in cancer treatment and outcomes, not all sites of metastases contribute equally to disease specific survival. Patients with metastatic squamous cell carcinoma of the oral cavity and oropharynx are at increased risk of disease specific death with metastases of the bone, lung, or metastasis of multiple sites, when compared to the liver or brain. These findings may guide individualized disease management.