A Meta-analysis of Surgical Outcomes of T4a and Infranotch T4b Oral Cancers

Karthik Nagaraja Rao; Ripudaman Arora; Prajwal Dange; Nitin Nagarkar; Antti A Mäkitie; Luiz P Kowalski; Avraham Eisbruch; Marc Hamoir; Francisco J Civantos; Vincent Vander Poorten; Sweet Ping Ng; Sandra Nuyts; Mark Zafereo; Ameya A Asarkar; Paweł Golusinski; Ohad Ronen; Alfio Ferlito

doi:10.1007/s40487-023-00246-3

A Meta-analysis of Surgical Outcomes of T4a and Infranotch T4b Oral Cancers

Oncol Ther. 2023 Dec;11(4):461-480. doi: 10.1007/s40487-023-00246-3. Epub 2023 Oct 7.

Authors

Karthik Nagaraja Rao¹, Ripudaman Arora², Prajwal Dange³, Nitin Nagarkar², Antti A Mäkitie⁴, Luiz P Kowalski⁵, Avraham Eisbruch⁶, Marc Hamoir⁷, Francisco J Civantos⁸, Vincent Vander Poorten^{9

10}, Sweet Ping Ng^{11

12

13

14}, Sandra Nuyts^{15

16}, Mark Zafereo¹⁷, Ameya A Asarkar¹⁸, Paweł Golusinski¹⁹, Ohad Ronen^{20

21}, Alfio Ferlito²²

Affiliations

¹ Department of Head and Neck Surgical Oncology, All India Institute of Medical Sciences, Raipur, India. karthik.nag.rao@gmail.com.
² Department of Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, Raipur, India.
³ Department of Head and Neck Surgical Oncology, All India Institute of Medical Sciences, Raipur, India.
⁴ Department of Otorhinolaryngology, Head and Neck Surgery, Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
⁵ Department of Head and Neck Surgery and Otorhinolaringology, A.C. Camargo Cancer Center, São Paulo, Brazil.
⁶ Department of Radiation Oncology, University of Michigan Medicine, Ann Arbor, MI, USA.
⁷ Department of Head and Neck Surgery, UC Louvain, St Luc University Hospital and King Albert II Cancer Institute, 1200, Brussels, Belgium.
⁸ Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.
⁹ Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium.
¹⁰ Department of Oncology, Section Head and Neck Oncology, Leuven Cancer Institute, KU Leuven, Leuven, Belgium.
¹¹ Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Australia.
¹² Department of Surgery, The University of Melbourne, Melbourne, Australia.
¹³ School of Cancer Medicine, La Trobe University, Melbourne, Australia.
¹⁴ School of Imaging and Radiation Sciences, Monash University, Melbourne, Australia.
¹⁵ Laboratory of Experimental Radiotherapy, Department of Oncology, Leuven Cancer Institute, University Hospitals Leuven, 3000, Leuven, Belgium.
¹⁶ Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, 3000, Leuven, Belgium.
¹⁷ Department of Head & Neck Surgery, MD Anderson Cancer Center, Houston, TX, 77005, USA.
¹⁸ Department of Otolaryngology Head and Neck Surgery, Louisiana Health Sciences Center, Shreveport, LA, USA.
¹⁹ Department of Otolaryngology and Maxillofacial Surgery, University of Zielona Gora, 65-417, Zielona Gora, Poland.
²⁰ Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel.
²¹ Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
²² Coordinator of the International Head and Neck Scientific Group, 35100, Padua, Italy.

Abstract

Objective: To determine the overall surgical outcomes of infranotch T4b oral cancers and compare them with T4a oral cancers.

Methods: PubMed, EMBASE and Cochrane databases from 2000 to 2022 were systematically searched. Clinical studies reporting at least one outcome following curative surgery and adjuvant therapy for comparison of patients with either infranotch T4b (IN-T4b) or T4a tumour. The heterogeneity of the included studies was determined using Tau-squared, Chi-squared, and the Higgins I² test. The random effects model was used to determine the log odds ratio (logOR).

Results: The systematic review comprised 11,790 patients from 16 included studies. Seven studies were included in the meta-analysis (n = 11,381). For IN-T4b patients, the pooled 2 and 5 year overall survival (OS) were 59.3% and 53.2%, 2 and 5 year disease-free survival (DFS) 57.9% and 48.4%, 2 and 5 year disease-specific survival (DSS) 72% and 68%, and 2 and 5 year local control (LC), 47% and 56%, respectively. There was no statistically significant difference in 2 year OS [logOR = 0.28 (-0.47, 1.03), p = 0.46, confidence interval (CI) = 95%], 5 year OS [logOR = 0.7 (-0.4, 1.8), p = 0.54, CI = 95%], 2 year DFS [logOR = 0.22 (-0.35, 0.79), p = 0.45, CI = 95%], 5 year DFS [logOR = 0.17 (-0.42, 0.77), p = 0.57, CI = 95%], 2 year LC [logOR = 0.47 (-0.33, 1.26), p = 0.25, CI = 95%] and 5 year LC [logOR = 0.34 (-0.31, 0.99), p = 0.31, CI = 95%] between IN-T4b and T4a oral cancers.

Conclusion: Results of this meta-analysis suggest that IN-T4b oral cancers have similar outcomes to T4a oral cancers, which supports down-staging IN-T4b cancers to T4a cancers.

Keywords: Head and neck cancer; Infratemporal fossa; Oral cavity cancer; Outcomes; T4b classification.

Publication types

Review