Definitive radiotherapy or surgery for early oral squamous cell carcinoma in old and very old patients: A propensity-score-matched, nationwide, population-based cohort study

Wen Chi Liu, Hsueh Erh Liu, Yi Wei Kao, Lei Qin, Kuan Chou Lin, Chih Yuan Fang, Lo Lin Tsai, Ben Chang Shia, Szu Yuan Wu

Research output: Contribution to journalArticle

Abstract

Purpose: Although patients aged >70 years are subject to early oral cavity squamous cell carcinoma (E-OCSCC), evidence is currently lacking regarding the probable outcomes of definitive radiotherapy (RT) compared to surgery in this population. Methods: We recruited patients aged ≥70 years with a diagnosis of E-OCSCC from the Taiwan Cancer Registry Database. Propensity score matching was performed, and Cox proportional-hazards model curves were used to analyze all-cause mortality of patients at different age intervals undergoing different treatments. Results: The matching process yielded a final cohort of 604 patients in the definitive RT and surgery cohorts who were eligible for further analysis. These patients were classified as old (70–80 years) and very old (>80 years). In the multivariate Cox regression analysis, the adjusted hazard ratio (aHR) (95% confidence interval [CI]) for surgery compared with definitive RT was 0.465 (0.354–0.610, P < 0.001). The aHR (95% CI) for age >80 years compared with age 70–80 years was 2.370 (1.720, 3.265, P < 0.001). The aHR (95% CI) for T2N0M0 compared with T1N0M0 was 1.752 (1.321–2.32, P < 0.001). The aHR (95% CI) for Charlson Comorbidity Index (CCI) ≥ 2 compared with CCI = 0 was 1.264 (1.137–1.738, P = 0.011). After stratified analysis, the aHRs for surgery compared with definitive RT were 0.484 (0.352–0.665, P < 0.001) and 0.411 (0.232–0.728, P = 0.002) among old and very old patients with E-OCSCC, respectively. Conclusions: Surgery may be more beneficial than definitive RT in selected elderly patients with E-OCSCC.

Original languageEnglish
Pages (from-to)214-221
Number of pages8
JournalRadiotherapy and Oncology
Volume151
DOIs
Publication statusPublished - Oct 2020

Keywords

  • Early stage
  • Old
  • Oral cavity squamous cell carcinoma
  • Radiotherapy
  • Surgery

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

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