title: Analysis of death certification in patients with early stage oral cavity squamous cell carcinoma.
abstract: OBJECTIVE
  Although patients with T1 oral cavity carcinoma have a generally good prognosis, there is a significant burden of patients that have locoregional recurrence and mortality from early stage disease. The aim of this study was to investigate the specific cause of death in patients with T1N0M0 oral cavity squamous cell carcinoma (OCSCC) by analysis of death certification.
  
  
  METHODS
  Patients were identified with T1 OCSCC treated over a 15-year period between 1986 to 2001 from the Mayo Clinic Tumor Registry. All patients were treated by operation without neck dissection or postoperative neoadjuvant therapy as the initial method of treatment. On detailed examination of the death certificate the leading cause of death was identified along with other clinical predictors of death.
  
  
  RESULTS
  Two hundred fifty patients were identified and met inclusion criteria from the Mayo Clinic Tumor Registry. Of the study group, 8.5% and 16% developed local and regional recurrence, respectively, as the first recurrence. The majority of recurrences that were amenable to surgery were managed by radical resection and postoperative neoadjuvant therapy. Of 85 deaths in the study group, 40 death certificates were obtained and reviewed to ascertain a specific cause of death. Patients were grouped into death from oral cancer, other cancer, or medical disease. Primary cause of death from the death certificates available for review included uncontrolled locoregional disease (20%), metastatic oral cancer (15%), development of secondary nonoral malignancy (15%), and a variety of medical causes (50%). Patient age at the time of diagnosis older than 65 had a statistically significant increase in mortality. Interestingly, the presence of premorbid medical conditions, history, or persistent tobacco and alcohol use did not seem to be related to overall mortality.
  
  
  CONCLUSIONS
  Early stage OCSCC continues to portend a poor prognosis. Analysis of death certification provides useful information of the specific cause of death.
authors.affiliation: Division of Oral and Maxillofacial Surgery, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. Kademani.deepak@mayo.edu
authors.forename: Deepak
authors.initials: D
authors.lastname: Kademani
authors.forename: Evre
authors.initials: E
authors.lastname: Baltali
authors.forename: Evre
authors.initials: E
authors.lastname: Baltlai
authors.forename: Jason
authors.initials: J
authors.lastname: Lewis
authors.forename: Eugene
authors.initials: E
authors.lastname: Keller
mesh_terms: D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000401:mortality; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D002423:Cause of Death; D015331:Cohort Studies; D003644:Death Certificates; D004194:Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D009062:Mouth Neoplasms / Q000401:mortality* / Q000601:surgery; D020360:Neoadjuvant Therapy / Q000706:statistics & numerical data; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery; D016609:Neoplasms, Second Primary / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012907:Smoking / Q000401:mortality