Does Operable Stage IV Gingivobuccal Cancers Need Further Prognostic Subgrouping?
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ORIGINAL ARTICLE
Does Operable Stage IV Gingivobuccal Cancers Need Further Prognostic Subgrouping? Saurabh Jain1 • Sultan Pradhan2 • Rajan Kannan2 • Smruti Mokal3 Shubhada Khanapure4 • Azmat Doctor5
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Received: 18 August 2020 / Accepted: 2 September 2020 Ó Association of Otolaryngologists of India 2020
Abstract Background Operable stage IV gingivobuccal complex cancer is classified as Stage IVA and IVB. Among patients with Stage IVA disease, different subgroups with likely different prognoses are combined. Patients with advanced nodal status tend to have a poorer prognosis. We divided these patients into four groups: group I (T4aN0), group II (T4aN1-2), group III (T1-3N2) constituting stage IVA category, and group IV (TanyN3) representing stage IVB. This study assesses if these patients can be prognostically subgrouped based on nodal status. Methods It is a prospective observational study done at a tertiary care center from July 2017 to June 2020. This study aims to analyze survival outcomes in these subgroups using Kaplan Meir, univariate and multivariate analysis. Results The study enrolled 113 patients of operable gingivobuccal complex stage IVA cancer with a median follow up of 26 months, disease-free survival (DFS) was 74% for group 1, while it was 55%, 26% and 32.2% for group 2, group 3 and group 4 respectively. Patients with T4N3 disease had DFS of just 15%. Patients in group 3 and 4 had the worst outcomes in terms of DFS and Overall & Saurabh Jain [email protected] 1
DNB Surgical Oncology Resident, Department of Surgical Oncology, Prince Aly Khan Hospital, Mumbai, Maharashtra 400010, India
2
Department of Surgical Oncology, Prince Aly Khan Hospital, Mumbai, India
3
Tata Memorial Hospital, Mumbai, India
4
DNB Surgical Oncology Resident, Prince Aly Khan Hospital, Mumbai, India
5
Plastic Surgeon, Prince Aly Khan Hospital, Mumbai, India
Survival(OS) with HR-3.7 and 3.3 and 3.3 and 3.8 respectively (p value-0.001). Conclusion The nodal status is the most important prognostic factor affecting DFS and OS. Patients with small primary but advanced nodal stage do poorly than patients with advanced primary and node-negative disease. There is a need for subgrouping patients with Stage IVA tumors based on nodal status for better prognostication. Keywords Gingivobuccal Nodal status Stage IV Subgrouping Survival
Introduction Squamous cell carcinoma of the gingivobuccal complex is predominantly a problem in a country like India where tobacco chewing is the main culprit for these cancers [1, 2]. The gingivobuccal complex includes the buccal mucosa, lower gingivobuccal sulcus, lower gingiva, and retromolar trigone. These cancers mostly present in the advanced stages requiring morbid surgeries [1, 2]. AJCC 8th edition recognizes buccal mucosa, lower alveolus and retromolar trigone as separate sites while the classification of gingivobuccal sulcus tumors is done with buccal mucosa or lower alveolus depending on the epicenter of the disease [3]. As per AJCC 8th edition, the Stage IV cancers are divi
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