Outcomes of oral tongue cancer: does age matter?

Purpose/Objective(s) Retrospective study to examine the outcomes of radically treated oral tongue squamous cell carcinoma with emphasis on young tongues in the National Cancer Centre, Singapore. Materials/Methods All patients treated with curative intent from 1998 to 2006 were included. They were classified according to treatment received: surgery alone (Group A), surgery with adjuvant therapy (Group B) and radical radiotherapy (RT) or chemoRT (CRT) (Group C) and stratified according to age groups (≤40 and >40 years old). Overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan-Meier method. Fisher exact test was used to analyze the differences between the groups. p<0.05 was deemed significant. Results A total of 123 patients were included with 39 (32%), 65 (53%) and 19 (15%) patients in Group A, B and C, respectively. There were 68% males and 32% females. Median age for all patients was 56 years old (range 18-87). Fifteen percent of Group A and B and 12% of Group C were ≤ 40 years old. Group B and C had more advanced disease with 86% and 95% diagnosed with Stage III/IV respectively, compared to 15% in Group A (p<0.05). Concurrent CRT was given to 14% of patients in Group B and 79% of Group C. Median follow-up was 29.1 weeks (range 1.2-150.3). Five-year OS and DFS were significantly better in Group A (69%/72%) followed by Group B (41%/47%) and C (16%/10%). Younger patients had better OS (5-year OS for ≤40 and >40: Group A: 83%/66%; Group B: 75%/36% and Group C: 33%/13%; p 0.012). Univariate analysis revealed T, N, and tumor stage, age, LVI, PNI, extranodal extension (ENE) but not surgical margins, to be significant factors for OS. However, younger patients had worse DFS than the older cohort in Group A (33% vs. 73%) and C (0% vs. 12%) but this was not statistically significant. Univariate analysis showed that T, N and tumor stage as well as ENE were significant factors for DFS but age, PNI, LVI and surgical margins were not. Young tongues had less advanced disease with lower rates of LVI, PNI and ENE compared to older patients (p>0.05). In Group A, 50% of the younger cohort (3/6) had local failure compared to 13% (1/8) in Group B and 100% (3/3) in Group C. Local failure occurred in 30%, 42% and 50% of the older patients in those groups respectively (p>0.05). Rates of distant failure were higher in the older cohort in all 3 groups (Group A: 0%/12%, Group B: 13%/14% and Group C: 0%/31%) but not significantly so. Conclusions Survival was better in surgically treated patients but this could be due to their lower initial relapse risk and patients given radical RT typically had more advanced disease. However, the survival and control rates in the adjuvant and radical RT groups remained dismal, hence concurrent chemoRT should be considered. Lastly, younger patients did not appear to have worse pathological features or clinical outcomes compared to the older population.