Priority of Fibular Reconstruction in Patients with Oral Cavity Cancer Undergoing Segmental Mandibulectomy
Identifieur interne : 000C04 ( Ncbi/Curation ); précédent : 000C03; suivant : 000C05Priority of Fibular Reconstruction in Patients with Oral Cavity Cancer Undergoing Segmental Mandibulectomy
Auteurs : Chih-Hung Lin [République populaire de Chine] ; Chung-Jan Kang [République populaire de Chine] ; Chung-Kan Tsao [République populaire de Chine] ; Christopher Glenn Wallace [République populaire de Chine] ; Li-Yu Lee [République populaire de Chine] ; Chien-Yu Lin [République populaire de Chine] ; Hung-Ming Wang [République populaire de Chine] ; Shu-Hang Ng [République populaire de Chine] ; Tzu-Chen Yen [République populaire de Chine] ; Chun-Ta Liao [République populaire de Chine]Source :
- PLoS ONE [ 1932-6203 ] ; 2014.
Abstract
The fibula osteoseptocutaneous free flap is generally used for segmental mandibular reconstructions following resection of oral cavity squamous cell carcinoma (OSCC). However, less complex reconstructions may be feasible for patients with predicted poor survival. Herein, we sought to identify the main risk factors (RFs) associated with poor prognosis in OSCC patients undergoing segmental mandibulectomy to help decide between fibular and non-fibular reconstructions.
Between 1996 and 2011, we examined the 5-year control, distant metastases, and survival rates in 310 consecutive, previously untreated patients with primary OSCC who underwent segmental mandibulectomy.
Margin status was the only independent RF for 5-year local control. Level IV/V metastases, extracapsular spread, and tumor depth ≥15 mm were independent RFs for poor 5-year survival. In the entire study cohort, 23% of the patients had 2 or 3 adverse RFs; such a high-risk group was characterized by a poor prognosis and may be suitable for non-fibular reconstructions. Overall, 70% of the study patients were cT1-4N0, cT1N2, cT2N1, or had tumor depth <15 mm; less than 5% of patients in this subgroup had 2 or 3 adverse RFs and were thus candidates for fibular reconstructions. Among the remaining 30% of patients who showed both advanced clinical stage (cT2N2, cT3-4N1-2) and tumor depth ≥15 mm, 70% exhibited 2 or 3 adverse RFs.
Level IV/V metastases, extracapsular spread, and tumor depth ≥15 mm were independent predictors of poor prognosis in OSCC patients undergoing segmental mandibulectomy. The preoperative or intraoperative identification of adverse RFs may help decide between fibular and non-fibular mandibular reconstruction. High-risk patients bearing 2 or 3 adverse RFs have poor prognosis and should not be considered as candidates for fibular reconstructions.
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DOI: 10.1371/journal.pone.0094315
PubMed: 24722353
PubMed Central: 3983152
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Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Wallace, Christopher Glenn" sort="Wallace, Christopher Glenn" uniqKey="Wallace C" first="Christopher Glenn" last="Wallace">Christopher Glenn Wallace</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Lee, Li Yu" sort="Lee, Li Yu" uniqKey="Lee L" first="Li-Yu" last="Lee">Li-Yu Lee</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, 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id="aff6"><addr-line>Department of Medical Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Medical Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Ng, Shu Hang" sort="Ng, Shu Hang" uniqKey="Ng S" first="Shu-Hang" last="Ng">Shu-Hang Ng</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff7"><addr-line>Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Yen, Tzu Chen" sort="Yen, Tzu Chen" uniqKey="Yen T" first="Tzu-Chen" last="Yen">Tzu-Chen Yen</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff8"><addr-line>Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Liao, Chun Ta" sort="Liao, Chun Ta" uniqKey="Liao C" first="Chun-Ta" last="Liao">Chun-Ta Liao</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24722353</idno><idno type="pmc">3983152</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3983152</idno><idno type="RBID">PMC:3983152</idno><idno 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Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Kang, Chung Jan" sort="Kang, Chung Jan" uniqKey="Kang C" first="Chung-Jan" last="Kang">Chung-Jan Kang</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Tsao, Chung Kan" sort="Tsao, Chung Kan" uniqKey="Tsao C" first="Chung-Kan" last="Tsao">Chung-Kan Tsao</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Wallace, Christopher Glenn" sort="Wallace, Christopher Glenn" uniqKey="Wallace C" first="Christopher Glenn" last="Wallace">Christopher Glenn Wallace</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Lee, Li Yu" sort="Lee, Li Yu" uniqKey="Lee L" first="Li-Yu" last="Lee">Li-Yu Lee</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Lin, Chien Yu" sort="Lin, Chien Yu" uniqKey="Lin C" first="Chien-Yu" last="Lin">Chien-Yu Lin</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff5"><addr-line>Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Wang, Hung Ming" sort="Wang, Hung Ming" uniqKey="Wang H" first="Hung-Ming" last="Wang">Hung-Ming Wang</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff6"><addr-line>Department of Medical Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Medical Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Ng, Shu Hang" sort="Ng, Shu Hang" uniqKey="Ng S" first="Shu-Hang" last="Ng">Shu-Hang Ng</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff7"><addr-line>Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Yen, Tzu Chen" sort="Yen, Tzu Chen" uniqKey="Yen T" first="Tzu-Chen" last="Yen">Tzu-Chen Yen</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff8"><addr-line>Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Liao, Chun Ta" sort="Liao, Chun Ta" uniqKey="Liao C" first="Chun-Ta" last="Liao">Chun-Ta Liao</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>The fibula osteoseptocutaneous free flap is generally used for segmental mandibular reconstructions following resection of oral cavity squamous cell carcinoma (OSCC). However, less complex reconstructions may be feasible for patients with predicted poor survival. Herein, we sought to identify the main risk factors (RFs) associated with poor prognosis in OSCC patients undergoing segmental mandibulectomy to help decide between fibular and non-fibular reconstructions.</p></sec><sec><title>Methods</title><p>Between 1996 and 2011, we examined the 5-year control, distant metastases, and survival rates in 310 consecutive, previously untreated patients with primary OSCC who underwent segmental mandibulectomy.</p></sec><sec><title>Results</title><p>Margin status was the only independent RF for 5-year local control. Level IV/V metastases, extracapsular spread, and tumor depth ≥15 mm were independent RFs for poor 5-year survival. In the entire study cohort, 23% of the patients had 2 or 3 adverse RFs; such a high-risk group was characterized by a poor prognosis and may be suitable for non-fibular reconstructions. Overall, 70% of the study patients were cT1-4N0, cT1N2, cT2N1, or had tumor depth <15 mm; less than 5% of patients in this subgroup had 2 or 3 adverse RFs and were thus candidates for fibular reconstructions. Among the remaining 30% of patients who showed both advanced clinical stage (cT2N2, cT3-4N1-2) and tumor depth ≥15 mm, 70% exhibited 2 or 3 adverse RFs.</p></sec><sec><title>Conclusions</title><p>Level IV/V metastases, extracapsular spread, and tumor depth ≥15 mm were independent predictors of poor prognosis in OSCC patients undergoing segmental mandibulectomy. The preoperative or intraoperative identification of adverse RFs may help decide between fibular and non-fibular mandibular reconstruction. High-risk patients bearing 2 or 3 adverse RFs have poor prognosis and should not be considered as candidates for fibular reconstructions.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Wei, Fc" uniqKey="Wei F">FC Wei</name></author><author><name sortKey="Demirkan, F" uniqKey="Demirkan F">F Demirkan</name></author><author><name sortKey="Chen, Hc" uniqKey="Chen H">HC Chen</name></author><author><name sortKey="Chen, Ih" uniqKey="Chen I">IH Chen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wei, Fc" uniqKey="Wei F">FC Wei</name></author><author><name sortKey="Celik, N" uniqKey="Celik N">N Celik</name></author><author><name sortKey="Chen, Hc" uniqKey="Chen H">HC Chen</name></author><author><name sortKey="Cheng, Mh" uniqKey="Cheng M">MH Cheng</name></author><author><name sortKey="Huang, Wc" uniqKey="Huang W">WC Huang</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Liao, Ct" uniqKey="Liao C">CT Liao</name></author><author><name sortKey="Lee, Ly" uniqKey="Lee L">LY Lee</name></author><author><name sortKey="Hsueh, C" uniqKey="Hsueh C">C Hsueh</name></author><author><name sortKey="Lin, Cy" uniqKey="Lin C">CY Lin</name></author><author><name sortKey="Fan, Kh" uniqKey="Fan K">KH Fan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Liao, Ct" uniqKey="Liao C">CT Liao</name></author><author><name sortKey="Chang, Jt" uniqKey="Chang J">JT Chang</name></author><author><name sortKey="Wang, Hm" uniqKey="Wang H">HM Wang</name></author><author><name sortKey="Ng, Sh" uniqKey="Ng S">SH Ng</name></author><author><name sortKey="Hsueh, C" uniqKey="Hsueh C">C Hsueh</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Liao, Ct" uniqKey="Liao C">CT Liao</name></author><author><name sortKey="Lee, Ly" uniqKey="Lee L">LY Lee</name></author><author><name sortKey="Huang, Sf" uniqKey="Huang S">SF Huang</name></author><author><name sortKey="Chen, Ih" uniqKey="Chen I">IH Chen</name></author><author><name sortKey="Kang, Cj" uniqKey="Kang C">CJ Kang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="O Brien, Cj" uniqKey="O Brien C">CJ O'Brien</name></author><author><name sortKey="Adams, Jr" uniqKey="Adams J">JR Adams</name></author><author><name sortKey="Mcneil, Eb" uniqKey="Mcneil E">EB McNeil</name></author><author><name sortKey="Taylor, P" uniqKey="Taylor P">P Taylor</name></author><author><name sortKey="Laniewski, P" uniqKey="Laniewski P">P Laniewski</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Saber, Tk" uniqKey="Saber T">TK Saber</name></author><author><name sortKey="Hussein, Ha" uniqKey="Hussein H">HA Hussein</name></author><author><name sortKey="Mebeed, Ah" uniqKey="Mebeed A">AH Mebeed</name></author><author><name sortKey="El Sebai, Hi" uniqKey="El Sebai H">HI El Sebai</name></author><author><name sortKey="Sami, I" uniqKey="Sami I">I Sami</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Munoz Guerra, Mf" uniqKey="Munoz Guerra M">MF Munoz Guerra</name></author><author><name sortKey="Naval Gias, L" uniqKey="Naval Gias L">L Naval Gias</name></author><author><name sortKey="Campo, Fr" uniqKey="Campo F">FR Campo</name></author><author><name sortKey="Perez, Js" uniqKey="Perez J">JS Perez</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Patel, Rs" uniqKey="Patel R">RS Patel</name></author><author><name sortKey="Dirven, R" uniqKey="Dirven R">R Dirven</name></author><author><name sortKey="Clark, Jr" uniqKey="Clark J">JR Clark</name></author><author><name sortKey="Swinson, Bd" uniqKey="Swinson B">BD Swinson</name></author><author><name sortKey="Gao, K" uniqKey="Gao K">K Gao</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Liao, Ct" uniqKey="Liao C">CT Liao</name></author><author><name sortKey="Chang, Jt" uniqKey="Chang J">JT Chang</name></author><author><name sortKey="Wang, Hm" uniqKey="Wang H">HM Wang</name></author><author><name sortKey="Ng, Sh" uniqKey="Ng S">SH Ng</name></author><author><name sortKey="Huang, Sf" uniqKey="Huang S">SF Huang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Liao, Ct" uniqKey="Liao C">CT Liao</name></author><author><name sortKey="Wang, Hm" uniqKey="Wang H">HM Wang</name></author><author><name sortKey="Huang, Sf" uniqKey="Huang S">SF Huang</name></author><author><name sortKey="Chen, Ih" uniqKey="Chen I">IH Chen</name></author><author><name sortKey="Kang, Cj" uniqKey="Kang C">CJ Kang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Johnson, Re" uniqKey="Johnson R">RE Johnson</name></author><author><name sortKey="Sigman, Jd" uniqKey="Sigman J">JD Sigman</name></author><author><name sortKey="Funk, Gf" uniqKey="Funk G">GF Funk</name></author><author><name sortKey="Robinson, Ra" uniqKey="Robinson R">RA Robinson</name></author><author><name sortKey="Hoffman, Ht" uniqKey="Hoffman H">HT Hoffman</name></author></analytic></biblStruct></listBibl></div1></back></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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