PURPOSE The evidence for adjuvant therapy of oral cavity squamous cell carcinoma (OCSCC) in National Comprehensive Cancer Network (NCCN) guidelines is derived from patients with head and neck cancer. Here, we examined whether adjuvant therapy should be guided by a detailed analysis of pathologic risk factors in patients with pure OCSCC. METHODS AND MATERIALS Between 2004 and 2016, we retrospectively reviewed 1200 consecutive patients with OCSCC who underwent radical surgery and neck dissection in the Chang-Gung Memorial Hospital (CGMH). Patients were divided into 3 prognostic groups. High-risk patients were those with extranodal extension (ENE) and/or positive margins (ENE/margins+, n = 267). Intermediate-risk patients were further divided into 3 subgroups: (1) patients in whom adjuvant therapy was indicated according to the CGMH but not the NCCN guidelines (NCCN[-]/CGMH[+], n = 14); (2) patients in whom adjuvant therapy was indicated by the NCCN but not the CGMH guidelines (NCCN[+]/CGMH[-], n = 160); and (3) patients in whom adjuvant therapy was indicated according to both guidelines (NCCN[+]/CGMH[+], n = 411). Low-risk patients were those for whom adjuvant therapy was not suggested in light of either guideline (NCCN[-]/CGMH[-], n = 348). RESULTS According to NCCN guidelines, postoperative adjuvant therapy was indicated in 69.8% of the participants. However, only 57.7% of patients were in need of adjuvant therapy by CGMH guidelines. The following 5-year outcomes were observed in the NCCN(-)/CGMH(-), NCCN(-)/CGMH(+), NCCN(+)/CGMH(-), NCCN(+)/CGMH(+), and ENE/margins+ subgroups: locoregional control, 88%/70%/83%/79%/68%, P < .001 (NCCN[+]/CGMH[-] vs NCCN[+]/CGMH[+], P = .576); distant metastases, 2%/7%/2%/9%/36%, P < .001 (NCCN[+]/CGMH[-] vs NCCN[+]/CGMH[+], P = .003); disease-specific survival, 97%/86%/94%/84%/56%, P < .001 (NCCN[+]/CGMH[-] vs NCCN[+]/CGMH[+], P < .001); and overall survival, 92%/86%/87%/68%/42%, P < .001 (NCCN[+]/CGMH[-] vs NCCN[+]/CGMH[+], P < .001), respectively. CONCLUSIONS Patients in the NCCN(+)/CGMH(-) subgroup, 28% (160/571[160 + 411]) of NCCN intermediate-risk patients, had more favorable 5-year disease-specific and overall survival (94% and 87%) than the NCCN(+)/CGMH(+) subgroup. The former are unlikely to derive clinical benefits from NCCN guidelines. The 70% adjuvant therapy rate required by NCCN guidelines after radical surgery might be too high, ultimately leaving room for improvement.

中文翻译：

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基于详细病理危险因素的精密辅助治疗，用于切除口腔腔鳞状细胞癌：CGMH和NCCN指南的长期结果比较。

目的国家综合癌症网络（NCCN）指南中口腔鳞状细胞癌（OCSCC）辅助治疗的证据来自头颈癌患者。在这里，我们检查了是否应通过详细分析纯OCSCC患者的病理危险因素来指导辅助治疗。方法和材料2004年至2016年，我们回顾性分析了在长庚纪念医院（CGMH）接受连续根治性手术和颈清扫术的1200例OCSCC患者。将患者分为3个预后组。高危患者是指结外扩展（ENE）和/或切缘阳性（ENE / margins +，n = 267）的患者。中危患者又分为3个亚组：（1）根据CGMH而不是NCCN指南（NCCN [-] / CGMH [+]，n = 14）进行辅助治疗的患者；（2）NCCN指示辅助治疗但CGMH指南未指示辅助治疗的患者（NCCN [+] / CGMH [-]，n = 160）；（3）根据这两项指南（NCCN [+] / CGMH [+]，n = 411）进行辅助治疗的患者。低危患者是根据任何一项指南均未建议辅助治疗的患者（NCCN [-] / CGMH [-]，n = 348）。结果根据NCCN指南，有69.8％的参与者接受了术后辅助治疗。但是，根据CGMH指南，只有57.7％的患者需要辅助治疗。在NCCN（-）/ CGMH（-），NCCN（-）/ CGMH（+），NCCN（+）/ CGMH（-），NCCN（+）/ CGMH（+），和ENE / margins +子组：局部区域控制，88％/ 70％/ 83％/ 79％/ 68％，P <.001（NCCN [+] / CGMH [-]与NCCN [+] / CGMH [+]，P = .576）；远处转移率为2％/ 7％/ 2％/ 9％/ 36％，P <.001（NCCN [+] / CGMH [-]与NCCN [+] / CGMH [+]，P = .003）；疾病特异性生存率，97％/ 86％/ 94％/ 84％/ 56％，P <.001（NCCN [+] / CGMH [-]与NCCN [+] / CGMH [+]，P <.001） ; 和总生存率，为92％/ 86％/ 87％/ 68％/ 42％，P <.001（NCCN [+] / CGMH [-]与NCCN [+] / CGMH [+]，P <.001），分别。结论NCCN（+）/ CGMH（-）亚组中有28％（160/571 [160 + 411]）NCCN中危患者的5年疾病特异性和总体生存率更高（94％比NCCN（+）/ CGMH（+）子组高出87％）。前者不太可能从NCCN指南中获得临床收益。根治性手术后，NCCN指南要求的70％辅助治疗率可能太高，最终有待改善。