Γεώργιος Φραγκουλίδης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κωνσταντίνος Γ. Τούτουζας, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Θεοδόσιος Θεοδοσόπουλος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Background and Purpose: Squamous cell carcinoma of the lower lip represents a common type of cancer with a favorable prognosis. Different types of defect reconstruction after ablative surgery are described for maintenance of patients’ quality of life. The purpose of this study was to analyze the prognostic factors associated with the overall survival until recurrence.
Materials and Methods: The study retrospectively evaluates the outcome of 529 patients treated for lower lip cancer in 2 university hospitals during 1983-2014 in Athens, Greece. Oncological data as well as individual quality of life were investigated, based on information from patient records. Associations between time to recurrence (local and regional) and the variables of sex, age, preop radiation therapy, recurrence and nodal status, postop radiation therapy, treatment modality, tumor histopathologic type and coexisting cutaneous lesions were analyzed with Kaplan-Meier, log-rank and Cox regression methods. The result of the procedure (functional and aesthetic) was evaluated and associated with all the above prognostic factors using binary logistic regression.
Results: Of all patients, 425 (80.3%) were men, with a median age of 69 years (mean±sd: 67±14, range: 23-96) at the time of diagnosis. The median follow-up time of the patients was 14 months (mean±sd: 24±22, range: 1-170). The overall recurrence free survival rate was 90.4%. The postop radiation therapy, the result and the treatment modality were associated with recurrence (P<0.05) in uni-variate analysis. Patients who underwent direct closure of the defect (HR: 0.454, 95% CI: 0.243-0.848) and had recurrent lesion at the time of diagnosis (HR: 0.403, 95% CI: 0.162-1.005) showed lower recurrence rates in multivariate analysis (P<0.05). In the contrary, postop radiation therapy (HR: 85.243, 95% CI: 26.244-276.88) and coexisting lesions (HR: 2.768, 95% CI: 1.049-7.299) proved to work hazardously (P<0.05). No differences in patient survival were found regarding sex, age, histopathologic type and preop nodal status and radiation therapy of tumors. A worse final result was associated with preop radiation therapy and regional disease, postop local recurrence and radiation therapy, and coexisting lesion (p <0.05). The direct closure of the defect seemed to improve the final result (OR: 2.641, 95% CI: 1.178-5.921, p <0.05).
Conclusions: These findings indicate that although lip tumors are curable, early detection, diagnosis and treatment lead to even higher rates of recurrence free survival and quality of live after all. Importance of the early detection of lip cancer should be emphasized in all health care and cancer prevention campaigns directed to the public and professionals.
Lower lip, Squamous cell carcinoma, Surgery, Recurrence, Result