title: Prognostic factors and outcomes for salvage surgery in patients with recurrent squamous cell carcinoma of the tongue.
abstract: OBJECTIVE
  Recurrence rates of oral cancer following primary treatment have been reported in the range of 25-48%. However, salvage therapy remains a critical challenge to improving outcomes. Here, we investigated prognostic factors and outcomes for salvage surgery in patients with recurrent oral tongue squamous cell carcinoma (OTSCC).
  
  
  METHODS
  We retrospectively reviewed patients who were referred to Aichi Cancer Center, Japan, for the treatment of recurrent OTSCC. All patients included in the present study had undergone salvage surgery. Data to identify the predictive value of prognostic factors were available from 69 patients. Prognostic factors were assessed using Cox's proportional hazards regression analysis. Differences in overall survival between groups of patients were assessed by the log-rank test.
  
  
  RESULTS
  In all, 36 patients (52%) developed second recurrence or died, of which 21 (58%) occurred within 12 months of salvage surgery. Univariate analysis indicated that survival was significantly worse in patients with recurrent stage III or IV tumors, two or more positive cervical lymph nodes, levels IV or V positive cervical lymph nodes, extracapsular spread (ECS) of positive cervical lymph nodes and a disease-free interval from initial treatment of less than 12 months. On multivariate analysis, ECS was an independent prognostic factor for overall survival after salvage surgery.
  
  
  CONCLUSIONS
  Neck status at the time of salvage surgery, particularly ECS is a significant prognostic factor for surgical salvage. Survival was also influenced by the stage of the recurrent tumor and disease-free interval, suggesting that the biological features of recurrent tumors might impact on prognosis.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Aichi Gakuin University.
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Goto
authors.affiliation: Department of Head and Neck Surgery, Aichi Cancer Center.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Hanai
authors.affiliation: Department of Head and Neck Surgery, Aichi Cancer Center.
authors.forename: Taijiro
authors.initials: T
authors.lastname: Ozawa
authors.affiliation: Department of Head and Neck Surgery, Aichi Cancer Center.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hirakawa
authors.affiliation: Department of Head and Neck Surgery, Aichi Cancer Center.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Department of Plastic and Reconstructive Surgery, Aichi Cancer Center.
authors.forename: Ikuo
authors.initials: I
authors.lastname: Hyodo
authors.affiliation: Department of Therapeutic Radiation Oncology, Aichi Cancer Center.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kodaira
authors.affiliation: Department of Otorhinolaryngology, Aichi Medical University School of Medicine, Nagakute.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ogawa
authors.affiliation: Department of Otolaryngology, Nagoya University Graduate School of Medicine.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Fujimoto
authors.affiliation: Department of Otorhinolaryngology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Terada
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Otolaryngology, Gifu University Hospital, Gifu, Japan.
authors.forename: Hisakazu
authors.initials: H
authors.lastname: Kato
authors.affiliation: Department of Head and Neck Surgery, Aichi Cancer Center.
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Hasegawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019647:Oral Surgical Procedures; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D014062:Tongue Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*
keywords: oral cavity; prognostic factor; recurrence; salvage surgery; squamous cell carcinoma