title: Temporal trends in outcome of oral squamous cell cancer in a resource-limited setting.
abstract: OBJECTIVE
  Improving survival has been documented for oral squamous cell carcinoma in recent years. It is a common malignancy in Pakistan but survival outcomes have not been reported. The objective of this study was to determine survival and identify independent predictors in patients with oral squamous cell cancer in 2 different time periods.
  
  
  METHODS
  A retrospective review of patients who received treatment between 2003 and 2012 was performed. Patients were divided into two 5 year groups: group 1 (2003-2007) (n = 628) and group 2 (2008-2012) (n = 920). Demographics, risk factors, treatment approaches, and outcomes were compared. Disease-free and overall survival were calculated. Cox proportional hazard model was used to determine independent predictors of survival.
  
  
  RESULTS
  A significant difference was present for ethnicity and grade and clinical T and N stage of tumors, with earlier presentation in group 2. More patients underwent surgery (p = 0.001) and had radical treatment intent (p&lt;0.0001) in recent years. Induction chemotherapy (p&lt;0.0001) and palliative chemotherapy (p&lt;0.0001) were used more frequently. No significant difference in disease-free survival was observed but overall 5-year survival improved significantly (23% vs 42%) (p&lt;0.0001). Use of palliative chemotherapy reduced risk of death significantly (hazard ratio [HR] 0.1, confidence interval [CI] 0.02-0.4, p = 0.003), while pathologic nodal positivity significantly increased the risk (HR 2.5, CI 1-5.9, p = 0.03).
  
  
  CONCLUSIONS
  These results from a single cancer hospital demonstrate improvement in overall survival secondary to early detection, better patient selection, and use of palliative chemotherapy in the later period.
authors.affiliation: Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore - Pakistan.
authors.forename: Abu Bakar
authors.initials: AB
authors.lastname: Hafeez Bhatti
authors.affiliation: Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore - Pakistan.
authors.forename: Arif
authors.initials: A
authors.lastname: Jamshed
authors.affiliation: Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore - Pakistan.
authors.forename: Hassan
authors.initials: H
authors.lastname: Iqbal
authors.affiliation: Radiation Oncology, Aga Khan University Hospital, Karachi - Pakistan.
authors.forename: Aqsa
authors.initials: A
authors.lastname: Hafeez
authors.affiliation: Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore - Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Irfan
authors.affiliation: Lahore Medical and Dental College, Lahore - Pakistan.
authors.forename: Sumayya
authors.initials: S
authors.lastname: Hameed
authors.affiliation: Aga Khan Medical College, Karachi - Pakistan.
authors.forename: Sarah
authors.initials: S
authors.lastname: Jamshed
authors.affiliation: Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore - Pakistan.
authors.forename: Raza
authors.initials: R
authors.lastname: Hussain
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001364:Awareness; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D017024:Chemotherapy, Adjuvant; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D006295:Health Resources / Q000600:supply & distribution*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009062:Mouth Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D010154:Pakistan / Q000453:epidemiology; D010166:Palliative Care / Q000379:methods; D011237:Predictive Value of Tests; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D012648:Self Care / Q000639:trends; D016896:Treatment Outcome