title: Incidence and Outcomes of Patients With Oral Cavity Squamous Cell Carcinoma and Fourth Primary Tumors: A Long-term Follow-up Study in a Betel Quid Chewing Endemic Area.
abstract: The aim of this study was to explore the incidence and outcomes of patients with oral cavity squamous cell carcinoma (OSCC) and fourth primary tumors (PTs) in a betel-chewing endemic area.We retrospectively examined the records of 1836 OSCC patients who underwent radical tumor resection between 1996 and 2014. The outcome measures included the incidence and number of multiple PTs, the main risk factors, and their associations with overall survival (OS).Of the 1836 patients, 1400 (76.3%) had a single PT, 344 (18.7%) a second PT, 67 (3.6%) a third PT, and 25 (1.4%) a fourth PT. Univariate analyses (log-rank test) identified the following factors as significantly associated with a fourth PT: simultaneous first and second PTs, betel quid chewing, buccal subsite, and pT3-4 status. After allowance for the potential confounding effect of other risk factors, all of these factors retained their independent prognostic significance in stepwise multivariate analyses, the only exception being betel chewing. The incidences of second, third, and fourth PTs at 5 and 10 years were 20.2%/34.6%, 4.0%/8.6%, and 1.0%/2.3%, respectively. The 5 and 10-year OS rates (calculated from the diagnosis of each PTs) for patients with a single, second, third, and fourth PTs were 68%/61%, 43%/37%, 45%/39%%, and 30%/30%, respectively (P < 0.0001). Among patients with a fourth PT, those who underwent radical surgery showed a significantly higher 3-year OS than those who did not (57% vs 13%; P = 0.0442).Fourth PTs are rarely observed in OSCC patients in a betel quid-chewing endemic area. Long-term survival rates of patients treated with radical surgery seems acceptable, being 4-fold higher than their counterparts.
authors.affiliation: From the Division of Surgical Oncology, Department of Surgery (MA), Al-Azhar University Hospital, Al-Azhar Faculty of Medicine, Cairo, Egypt; Department of Otorhinolaryngology, Head and Neck Surgery (MA, C-TL, S-FH, C-JK, K-HF, YCW, K-PC, T-JF); Head and Neck Oncology Group (C-TL, L-YL, CH, C-YL, K-HF, H-MW, S-HN, C-HL, C-KT, S-FH, C-JK, K-HF, Y-CW, K-PC, T-JF, LYY, T-CY), Chang Gung Memorial Hospital and Chang Gung University; Department of Pathology (L-YL, CH); Department of Radiation Oncology (C-YL, K-HF); Department of Medical Oncology (H-MW); Department of Diagnostic Radiology (S-HN); Department of Plastic and Reconstructive Surgery (C-HL, C-KT); Biostatistics and Informatics Unit, Clinical Trial Center (LYY); and Department of Nuclear Medicine and Molecular Imaging Center (T-CY), Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Adel
authors.forename: Chun-Ta
authors.initials: CT
authors.lastname: Liao
authors.forename: Li-Yu
authors.initials: LY
authors.lastname: Lee
authors.forename: Chuen
authors.initials: C
authors.lastname: Hsueh
authors.forename: Chien-Yu
authors.initials: CY
authors.lastname: Lin
authors.forename: Kang-Hsing
authors.initials: KH
authors.lastname: Fan
authors.forename: Hung-Ming
authors.initials: HM
authors.lastname: Wang
authors.forename: Shu-Hang
authors.initials: SH
authors.lastname: Ng
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Lin
authors.forename: Chung-Kan
authors.initials: CK
authors.lastname: Tsao
authors.forename: Shiang-Fu
authors.initials: SF
authors.lastname: Huang
authors.forename: Chung-Jan
authors.initials: CJ
authors.lastname: Kang
authors.forename: Ku-Hao
authors.initials: KH
authors.lastname: Fang
authors.forename: Yu-Chien
authors.initials: YC
authors.lastname: Wang
authors.forename: Kai-Ping
authors.initials: KP
authors.lastname: Chang
authors.forename: Tuan-Jen
authors.initials: TJ
authors.lastname: Fang
authors.forename: Lan Yan
authors.initials: LY
authors.lastname: Yang
authors.forename: Tzu-Chen
authors.initials: TC
authors.lastname: Yen
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D001114:Areca / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000139:chemically induced* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D003430:Cross-Sectional Studies; D019353:Endemic Diseases; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008409:Mastication; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000139:chemically induced* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000139:chemically induced* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000150:complications* / Q000401:mortality; D015996:Survival Rate; D013624:Taiwan