title: Risk Factors Associated with Disease Recurrence in Patients with Stage III/IV Squamous Cell Carcinoma of the Oral Cavity Treated with Surgery and Postoperative Radiotherapy.
abstract: OBJECTIVE
  The purpose of the present study was to identify variables associated with high risk of failure in patients with locally advanced squamous cell carcinoma of the oral cavity (SCC-OC).
  
  
  METHODS
  This retrospective study included 191 patients with stage III-IVb SCC-OC treated with post-operative radiotherapy (RT) or chemoradiotherapy (CRT) between 1995 and 2013. Disease-free (DFS) and overall survival (OS) were analyzed; variables associated with inferior DFS were identified.
  
  
  RESULTS
  Seventy-five patients (39%) recurred. DFS and five-year OS were 52% and 54%, respectively. Poorly differentiated tumors (p=0.03), recurrent tumors (p=0.02) and high nodal ratio (p=0.02) were associated with an increased risk of recurrence. CRT was associated with improved DFS in patients with positive margins and/or extracapsular extension (p=0.021).
  
  
  CONCLUSIONS
  Tumors that are recurrent, high grade, or have high nodal ratio are at risk of recurrence. Presence of these disease features should be taken into consideration for better risk stratification.
authors: Case Western Reserve University School of Medicine, Cleveland, OH, U.S.A.
authors: Anisha R
authors: AR
authors: Noble
authors: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, U.S.A.
authors: John F
authors: JF
authors: Greskovich
authors: Case Western Reserve University School of Medicine, Cleveland, OH, U.S.A.
authors: Jaehong
authors: J
authors: Han
authors: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, U.S.A.
authors: Chandana A
authors: CA
authors: Reddy
authors: Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, U.S.A.
authors: Tobenna I
authors: TI
authors: Nwizu
authors: Head and Neck Institute; Cleveland Clinic Foundation, Cleveland, OH, U.S.A.
authors: Mumtaz F
authors: MF
authors: Khan
authors: Head and Neck Institute; Cleveland Clinic Foundation, Cleveland, OH, U.S.A.
authors: Joseph
authors: J
authors: Scharpf
authors: Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, U.S.A.
authors: David J
authors: DJ
authors: Adelstein
authors: Head and Neck Institute; Cleveland Clinic Foundation, Cleveland, OH, U.S.A.
authors: Brian B
authors: BB
authors: Burkey
authors: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, U.S.A. koyfmas@ccf.org.
authors: Shlomo A
authors: SA
authors: Koyfman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000473:pathology / Q000528:radiation effects* / Q000601:surgery*; D009062:Mouth Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D019647:Oral Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000077195:Squamous Cell Carcinoma of Head and Neck; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Squamous cell carcinoma; chemoradiotherapy; disease-free survival; head and neck neoplasms; neoplasm recurrence; risk factors; survival rate