Definitive Resection for Occult Invasive Disease Recommended for Oral Cavity Carcinoma in Situ

by Amy E. Hamaker •

CLINICAL QUESTION

What are the rates of occult invasive disease and the clinical outcomes in patients with oral cavity carcinoma in situ (CIS), and what treatment do they support?

BOTTOM LINE

The rates and clinical outcomes

support the practice of definitive resection if feasible following a biopsy that demonstrates oral cavity CIS.

BACKGROUND: The likelihood that an oral cavity lesion harbors occult invasive disease after a biopsy that demonstrates carcinoma in situ (CIS) is unknown. Although de-escalated treatment strategies may be appealing, knowing whether occult invasive disease may be present and its association with survival outcomes would lead to more informed management decisions.

STUDY DESIGN: Retrospective population-based cohort study.

SETTING: Department of Radiation Medicine, Northwell Health Cancer Institute, Zucker School of Medicine at Hofstra/Northwell, Lake Success, N.Y.

SYNOPSIS: Using the National Cancer Database, researchers identified a total of 1,580 adult patients overall who had a biopsy-proven oral cavity CIS as the first cancer diagnosis between 2004 and 2020. Analyses calculated the rate of occult invasive disease identified on resection of a biopsy-proven CIS lesion. Researchers then identified significant demographic and clinical characteristics associated with risk of occult invasion (age, year of diagnosis, sex, race and ethnicity, oral cavity subsite, and comorbidity status). Among patients who proceeded with surgery with documented pathology, 408 were found to have occult invasive disease. Higher-risk features were present in 45 patients for final margin positivity, 16 for lymphovascular invasion, 13 for high-grade invasive disease, and 14 for nodal involvement. For patients with occult disease, staging according to the American Joint Committee on Cancer’s AJCC Cancer Staging Manual, eighth edition, was pT1 in 341 patients (83.6%), pT2 in 41 (10.0%), and pT3 or pT4 disease in 26 (6.4%). Factors associated with greater odds of occult invasive disease at resection were female sex, Black race, and alveolar ridge, vestibule, and retromolar subsite. With median 66-month follow-up, five-year OS was 85.9% in patients who proceeded with surgical resection vs. 59.7% in patients who did not undergo surgery (95%CI, 19.0%–33.4%).

CITATION: Cooper DJ, Ziemba Y, Pereira L, et al. Rates of occult invasive disease in patients with biopsy-proven oral cavity squamous cell carcinoma in situ. JAMA Otolaryngol Head Neck Surg. 2024;150:151–156.Amy E. Hamaker