title: Survival following primary surgery for oral cancer.
abstract: The main aims of this article are to report the overall and disease-specific survival of a consecutive series of patients presenting with oral cancer from 1992 to 2002 and to relate survival to clinical and pathological factors. The article uses population-based age-sex mortality rates in the North-West of England to highlight differences in overall and disease-specific survival. 541 patients with oral squamous cell carcinoma presented to the Regional Maxillofacial Unit from 1992 to 2002. Curative treatment favoured radical primary surgery, 10% (52) received primary radiotherapy. These patients were on average 8 years older with more advanced tumours and overall poorer survival at 5 years, 23% (SE 7%). The remainder of the results refer to 489 patients who had primary curative surgery, 40% (194) of whom received adjuvant radiotherapy. The overall survival (OS) was 56% (SE 2%) and the disease-specific survival (DSS) was 74% (SE 2%). There was a local recurrence rate of 10% (50) and the loco-regional recurrence rate was 21% (103). The second primary rate was 7% (35). Survival figures had improved over the 10-year period from 63% DSS for the first 4 years of the study (1992-1995) compared to 81% for the last 3 years (2000-2002). In stepwise Cox regression the two predictors selected for disease-specific survival were pN status and margins (both p<0.001). Age-sex mortality rates for the North-West indicate that 15.0% of the 489 primary surgery patients might have been expected to die within 5 years if they were typical of the general population and the observed difference between all causes and oral-cancer specific survival was 18.3%. These data emphasise the value of disease-specific survival as an indicator of successful treatment in a cohort that tends to be elderly, from social deprived backgrounds, with life styles and comorbidity that influence overall survival.
authors.affiliation: University Hospital Aintree Foundation Trust, Regional Oral and Maxillofacial Unit, Merseyside, United Kingdom. snrogers@doctors.org.uk
authors.forename: Simon N
authors.initials: SN
authors.lastname: Rogers
authors.forename: James S
authors.initials: JS
authors.lastname: Brown
authors.forename: Julia A
authors.initials: JA
authors.lastname: Woolgar
authors.forename: Derek
authors.initials: D
authors.lastname: Lowe
authors.forename: Patrick
authors.initials: P
authors.lastname: Magennis
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Shaw
authors.forename: David
authors.initials: D
authors.lastname: Sutton
authors.forename: Douglas
authors.initials: D
authors.lastname: Errington
authors.forename: David
authors.initials: D
authors.lastname: Vaughan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult