Clinical Outcomes in Advanced Oral Cavity Cancer: A Retrospective Analysis

Background: Advanced oral cavity squamous cell carcinoma (stage III–IV) carries a poor prognosis despite aggressive multimodal treatment. We performed a retrospective analysis of patients with advanced oral cancer to evaluate clinical characteristics and survival outcomes.
Methods: We identified 148 patients with stage III or IV oral cavity squamous cell carcinoma treated with curative intent. Demographic data, tumor features (TNM stage, subsites), and treatments (surgery, adjuvant radiotherapy, chemotherapy) were collected. Five-year overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan-Meier methodology. Survival differences by stage, nodal status, tumor subsite,
adjuvant therapy (chemotherapy or radiotherapy), age, and sex were compared with log-rank tests (significance
threshold p<0.05).
Results: The cohort’s mean age was 57 years (range 33–80); 84 patients (56.8%) were male. The majority of tumors were T4 (62.1% T4a/T4b), and 64.9% of patients had no nodal metastases (N0). Stage IV disease
constituted 67.6% of cases. Most patients (89.2%) received postoperative radiotherapy, and 24.3% received adjuvant chemotherapy following surgery. The 5-year OS for the entire cohort was 62.2%. By stage group, 5-year OS was 66.7% for stage III versus 60.0% for stage IV (log-rank p = 0.333). Nodal status significantly influenced OS: N0 patients had 70.8% 5-year OS vs 46.2% for N+ (p = 0.001). Patients who received adjuvant chemotherapy had worse survival than those who did not (44.4% vs 67.9% 5-year OS, p = 0.012). All 16 patients who did not receive radiotherapy were alive at 5 years (100% OS), whereas those treated with radiotherapy had 57.6% 5-year OS (p = 0.001). Survival also differed by primary tumor subsite (log-rank p = 0.038). For example, tongue, hard palate, and maxillary tuberosity tumors had 100% 5-year OS (no deaths), whereas tumors of the upper gingivobuccal sulcus had only ~43% 5-year OS. Patient age was prognostic (p = 0.007), with the youngest group (30–39 years) achieving 100% 5-year OS versus ~46% in those aged 50–59.
Sex was not significantly associated with OS (p = 0.055).
Conclusion: In this cohort of advanced oral cavity cancer, cervical nodal metastasis, tumor subsite, and younger age were associated with significantly better or worse survival outcomes, whereas overall stage (III vs IV) and patient sex were less discriminative. Multimodal therapy yielded an overall 5-year survival ~62%,
which is favorable compared to historical averages. These findings underscore the need to optimize regional nodal control and tailor adjuvant therapy for high-risk pathological features in order to improve outcomes.

Keywords: Advanced Oral Cavity Cancer, Oral Squamous Cell Carcinoma, Clinical Outcomes, Tumor Staging, Treatment Modalities, Prognostic Factors.