Research Paper
Head and Neck Oncology
Comparison of survival between palliative surgery and no surgery for advanced tongue squamous cell carcinoma: an analysis of SEER data

https://doi.org/10.1016/j.ijom.2024.07.001Get rights and content

Abstract

The aim of this study was to investigate the survival effect of palliative surgery in advanced tongue squamous cell carcinoma (TSCC). A retrospective analysis of data in the SEER database for 6151 patients with stage III/IV TSCC (American Joint Committee on Cancer (AJCC) staging), diagnosed between 2004 and 2015, was performed. The patients were divided into two groups: palliative surgery and no surgery. Kaplan–Meier and Cox proportional hazards regression analyses were applied to determine risk factors for overall survival (OS) and cancer-specific survival (CSS). A further analysis was performed using 1:1 propensity score matching (PSM) to balance 13 patient variables (sex, age at diagnosis, race, marital status, primary tumour site, SEER stage, AJCC stage, pathological differentiation grade, tumour size, lymph node metastasis, previous lymph node removal, radiotherapy, and chemotherapy). Among the 6151 patients, 706 underwent palliative surgery; the other 5445 did not undergo any kind of surgery. Those who underwent palliative surgery had a higher 5-year survival rate. After PSM, 1274 patients were included in the matched cohort. Multivariate Cox regression analysis showed that patients who underwent palliative surgery had a lower risk of death than those who did not (OS: hazard ratio 0.58, 95% confidence interval 0.49–0.69, P < 0.001; CSS: hazard ratio 0.60, 95% confidence interval 0.49–0.74, P < 0.001). In this comparative study it was found that compared with no surgery, palliative surgery has a positive impact on the survival rate of patients with advanced TSCC.

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Section snippets

Patient selection

The SEER database (Surveillance, Epidemiology, and End Results (SEER) Program, National Cancer Institute, USA) is currently the most extensive publicly available cancer database worldwide, covering about 30% of the population of the United States38. In this study, all cases were obtained from the SEER*Stat database available in April 2022 (version 8.4.0). Patients were included in this study if they met the following criteria: (1) patient found to be histologically positive for TSCC between

Demographic and clinical characteristics

A total of 6151 patients diagnosed with AJCC stage III or IV TSCC between 2004 and 2015 were included in this study. Of these patients, 706 underwent palliative surgical procedures, while 5445 did not undergo any kind of surgery. The distribution of the TSCC patients undergoing the various palliative surgical procedures is shown in Table 1. The demographic and clinical characteristics of the TSCC patients in the palliative surgery and no surgery groups are shown in Table 2. Pearson χ2 analysis

Discussion

Despite the potential complications such as facial disfigurement and functional impairments, surgical treatment remains the frontline option for patients with tongue cancer. However, in clinical practice, a considerable proportion of advanced tongue cancer patients are unable to tolerate or refuse surgical treatment and instead opt for palliative surgical interventions, achieving favourable outcomes. In the current study, it was found that in the specific context of advanced tongue cancer

Ethical approval

Not required.

Patient consent

Not applicable.

Funding

This work was financially supported by Wenzhou Municipal Science and Technology Bureau Projects, China (Grant No. Y20220378) and the Wenzhou Major Scientific and Technological Innovation Project (ZY2022022).

Competing Interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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    Z. Ye, G. Tan, and L. Wang are co-first authors.

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