Outcome predictors in squamous cell carcinoma of the maxillary alveolus and hard palate

Authors

  • Antoine Eskander HBSc, MD,

    1. Department of Otolaryngology–Head and Neck Surgery/Surgical Oncology, Wharton Head and Neck Program, University Health Network, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
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  • Babak Givi MD, FACS,

    1. Department of Otolaryngology–Head and Neck Surgery/Surgical Oncology, Wharton Head and Neck Program, University Health Network, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
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  • Patrick J. Gullane MB, FRCSC,

    1. Department of Otolaryngology–Head and Neck Surgery/Surgical Oncology, Wharton Head and Neck Program, University Health Network, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
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  • Jonathan Irish MD, MSc, FRCSC, FACS,

    1. Department of Otolaryngology–Head and Neck Surgery/Surgical Oncology, Wharton Head and Neck Program, University Health Network, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
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  • Dale Brown MB, BCh, FRCSC,

    1. Department of Otolaryngology–Head and Neck Surgery/Surgical Oncology, Wharton Head and Neck Program, University Health Network, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
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  • Ralph W. Gilbert MB, BCh, FRCSC,

    1. Department of Otolaryngology–Head and Neck Surgery/Surgical Oncology, Wharton Head and Neck Program, University Health Network, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
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  • Andrew Hope MD, FRCPC,

    1. Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
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  • Ilan Weinreb MD, FRCPC,

    1. Department of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada
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  • Wei Xu PhD,

    1. Department of Biostatistics, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
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  • David P. Goldstein MD, MSc, FRCSC

    Corresponding author
    • Department of Otolaryngology–Head and Neck Surgery/Surgical Oncology, Wharton Head and Neck Program, University Health Network, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Send correspondence to David P. Goldstein MD, MSc, FRCSC, Princess Margaret Hospital Rm 3-952, 610 University Ave, Toronto, Ontario M5G 2M9, Canada. E-mail: david.goldstein@uhn.on.ca

Abstract

Objectives/Hypothesis

Hard palate and maxillary alveolus are two commonly grouped oral cavity subsites due to their anatomic contiguity and oncologic disease behavior. Few studies have been conducted investigating clinical presentation, staging, prevalence of cervical metastases, and outcomes in this population. The primary objective of this study was to analyze predictors of disease-free survival (DFS) in surgically treated patients, particularly as it relates to the role of neck dissection.

Study Design

Cohort study with planned data collection.

Methods

This cohort study used planned data collection over 15 years (1994–2008) at a large tertiary care cancer center to study all patients presenting with squamous cell carcinoma of the maxillary alveolus and hard palate treated surgically. Univariate and multivariate Cox regression analyses were used to identify predictors of DFS.

Results

Ninety-seven patients met the inclusion criteria (54 male, 56%). The majority of patients (54, 56%) presented with locally advanced disease (cT3, cT4). Occult nodal metastases were noted in 26% (17 of 65) of patients clinically staged as N0. The 3-year DFS was 70% (95% confidence interval = 59%–78%) with a median time to failure of 1.1 years (range = 0.3–9.7 years). Cox regression multivariate model demonstrated that advanced pathologic T stage, hard palate tumor site, and poorly differentiated tumor grade were each independent predictors of DFS.

Conclusions

A significant portion of the patients with hard palate and maxillary alveolus tumors harbor occult cervical metastases. Elective neck dissection in the high-risk patients may potentially be beneficial in providing more accurate staging and improving DFS.

Level of Evidence

2b. Laryngoscope, 123:2453–2458, 2013

Ancillary