Date of Award

January 2016

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Benjamin L. Judson

Abstract

SHORT-TERM OUTCOMES AND LONG-TERM PROGNOSIS OF ORAL CAVITY CANCER. Zachary G. Schwam, Benjamin L. Judson (advisor). Section of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, CT.

We sought to characterize short-term morbidity and mortality outcomes as well as long-term changes in prognosis for oral cancer patients. We predicted that clinical and demographic variables would affect short- and long-term outcomes. Retrospective analyses of the National Surgical Quality Improvement Program (NSQIP) and National Cancer Database (NCDB) were performed on 408 and 13,655 patients, respectively. Chi-square, Kaplan Meier, logistic regression, and Cox proportional hazards regression were performed. In the NSQIP, the overall adverse event and mortality rates were 20.3% and 1.0%, respectively. The most common complications were reoperation, infection, and respiratory complications. Over 90% of post-discharge complications occurred by post-discharge day (PDD) 14, but the majority of surgical-site infections and dehiscences occurred by PDD 7. Neck dissection, smoking, and weight loss were associated with several complications in multivariate analysis. In the NCDB, three-year overall survival increased by 36.2% and 16.0% for patients with early and late stage disease (LSD), respectively. In LSD patients, adjuvant chemoradiotherapy increased from 8.3% to 36.4%. Later year of diagnosis (hazard ratio [HR] 0.76), neck dissection (HR 0.90), and negative margins (HR 1.00) were associated with better overall survival (all p≤.002). Many patients with oral cavity cancers experience postoperative complications, some of which occur post-discharge. Early follow-up should be sought for high-risk patients. Long-term prognosis for oral cancers has increased dramatically, as has the administration of adjuvant chemoradiotherapy in LSD. Numerous sociodemographic, clinical, and treatment variables may account for this difference in survival.

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