Introduction
Squamous cell (SCC) is the most common malignancy affecting the oral cavity1,2. It is most commonly seen in patients with a history of tobacco and/or heavy alcohol use2,3. SCCs arising from the buccal mucosa are more aggressive compared to those arising from other oral cavity subsites, with high rates of local recurrence and lower disease-free survival (DFS)4. Buccal SCC is relatively uncommon in North America and Western Europe, only accounting for 5-10% of all oral cavity SCC cases2,5,6. To date, most studies looking at buccal SCC are single-institution case series and retrospective reviews5,6,7. The present study aims to conduct a multi-institution review of oncologic and survival outcomes of patients with primary SCC of the buccal mucosa treated with upfront surgery.
Methods
A retrospective series of patients treated with initial surgical resection for buccal SCC from three separate tertiary head and neck cancer centers was utilized in this study. Survival analysis was performed using the Kaplan-Meier method, and descriptive statistics were generated using R. Software.
Results
A total of 88 patients met our inclusion criteria. The mean age of patients was 67 (SD 12.1) with a gender ratio of 53.4% male to 46.6% female. Patients presented with T1-T2 disease in 47/88 cases (53%). Occult nodal metastasis was observed in 23% of patients, whereas positive margins, perineural invasion, and extra-nodal extension were seen in 9%, 16%, and 17,% respectively. Thirty-six out of 88 patients (41%) received adjuvant radiation, and 12/88 patients (14%) received adjuvant chemoradiation. Two-year disease-specific survival (DSS) was 83.2% (SE=5.9%, 95%CI=74.2–93.4%, and 5-year DSS was 61.9% (SE=11.6%, 95%CI=49.3–77.7%).
Discussion
SCC originating in the buccal mucosa tends to exhibit aggressive pathologic features and disease recurrence. The 5-year DSS of 61.9% supports the need for comparing outcomes of buccal SCC with other subsites of the oral cavity. Ongoing analyses are investigating the impact of RT vs. CRT on survival in these patients and the impact of individual pathological features on recurrence.
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