Adjuvant Therapy Significant for Oncologic Outcomes After OSCC Resection

Refusal of recommended adjuvant therapy was associated with worse survival outcomes among patients with advanced oral squamous cell carcinoma (OSCC). These findings were published in JAMA Otolaryngology – Head & Neck Surgery.

Some patients with OSCC who undergo primary resection refuse adjuvant therapy. There remains a paucity of data about outcomes associated with adjuvant therapy refusal to best guide conversations with patients about potential consequences of refusing adjuvant therapy.

Patients with advanced OSCC who underwent primary resection between 2010 and 2021 at the Charité-Iniversitäts-medizin Berlin in Germany were included in this study. Forty-one patients who refused recommended adjuvant therapy were matched in a 1:1 ratio with 41 patients who completed adjuvant therapy. The primary outcomes were overall survival (OS) and recurrence-free survival (RFS).

Patients were aged mean 68.0 years (SD, 11.3) at the time of surgery and 53.7% were men.

At 2 years, the OS rates were 72.7% and 88.6% and the RFS rates were 39.1% and 74.2% in the patients who refused and completed adjuvant therapy, respectively.

In subgroup analyses, 2-year OS was reduced in women (difference, 41.9%) and patients with pT1-2 category (difference, 35.2%) or pN1 or higher category (difference, 21.4%) who refused adjuvant therapy relative to those who completed it. Similarly, 2-year RFS was reduced in women (difference, 53.0%) and patients with pT3-4 (difference, 44.7%), lymph node yield of 20 or more (difference, 49.2%), and a ratio of affected lymph nodes to all lymph nodes of less than 4.6% (difference, 47.8%) who refused adjuvant therapy relative to those who completed adjuvant therapy.

The major limitation of this study was its small sample size.

The study authors found that compared with adjuvant therapy completion, adjuvant therapy refusal was associated with poor oncologic outcomes including lower RFS, lower OS, and a 34% higher risk for disease recurrence.

Reference

Mrosk F, Doll C, Scheer J, et al. Oncologic Outcome in Advanced Oral Squamous Cell Carcinoma After Refusal of Recommended Adjuvant Therapy. JAMA Otolaryngol Head Neck Surg. Published online October 12, 2023. doi:10.1001/jamaoto.2023.3111