Outcomes and Prognostic Factors of Salvage Surgery for Recurrent Oral Squamous Cell Carcinoma.
5 affiliations
- 1Otorhinolaryngology Clinic, Careggi University Hospital, Florence-Largo Brambilla, 3, 50134 Florence, Italy.
- 2Otorhinolaryngology Unit, Ospedale Civile di Vigevano, ASST Pavia, 27029 Vigevano, Italy.
- 3Institute of Histopathology and Molecular Diagnosis, Careggi University Hospital, 50134 Florence, Italy.
- 4Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention, and Clinical Network (ISPRO), 50139 Florence, Italy.
- 5Research Unit in Periodontology and Periodontal Medicine, Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy.
Abstract
Background
Recurrent oral squamous cell carcinoma (rOSCC) is associated with a poor prognosis, and evidence supporting risk stratification in the salvage setting remains limited. The prognostic value of conventional staging systems and tumor-related characteristics after recurrence has not yet been fully established.Methods
We conducted a single-center observational study including patients with rOSCC who had previously undergone treatment for pT1-2 N0M0 OSCC, all subsequently surgically salvaged. Clinical, histopathological, and recurrence-related variables were collected. Recurrent tumors were classified according to the AJCC TNM staging system, the Composite Oral Cavity and Oropharynx Recurrence Staging System (CORSS), and the Same-Up-Down staging system (SUDss), a novel staging system developed by our group.Results
A total of 49 patients were included. Several pathological characteristics, including the rT3-4 category (p = 0.025), perineural invasion (p < 0.001), lymphovascular invasion (p = 0.003), greater depth of invasion (p = 0.011), nodal involvement (p = 0.002), and higher rTNM (p = 0.004) and CORSS stage (stage II p = 0.012; stage III p = 0.038) were associated with poorer OS in univariable analyses. In multivariable analysis, CORSS stage II (HR 2.89, 95% CI 1.04-8.04; p = 0.041) and stage III (HR 12.73, 95% CI 2.11-76.68; p = 0.005), as well as close/positive surgical margins (HR 2.57, 95% CI 0.99-6.71; p = 0.045) and pathological nodal involvement (HR 4.82, 95% CI 1.77-13.14; p = 0.002), were independently associated with poorer OS.Conclusions
CORSS appears to offer complementary prognostic value compared with conventional rTNM in patients with surgically treated rOSCC, although formal comparative validation of discrimination and calibration is warranted. Pathological lymph node involvement and close or positive surgical margins were the most relevant independent adverse prognostic factors. These findings identify higher-risk patients but do not, by themselves, establish a benefit from treatment intensification.
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BibTeX
@article{orlando2026outcomes,
title = {{Outcomes and Prognostic Factors of Salvage Surgery for Recurrent Oral Squamous Cell Carcinoma.}},
author = {Pietro Orlando and Letizia Flammia and Giuseppe Licci and Luca Novelli and Saverio Caini and Angelo Cannavicci and Lapo Serni and Oreste Gallo},
journal = {Cancers},
year = {2026},
month = sep,
doi = {10.3390/cancers18193113},
url = {https://europepmc.org/article/MED/42882808},
note = {CC BY},
}
RIS
TY - JOUR
TI - Outcomes and Prognostic Factors of Salvage Surgery for Recurrent Oral Squamous Cell Carcinoma.
AU - Pietro Orlando
AU - Letizia Flammia
AU - Giuseppe Licci
AU - Luca Novelli
AU - Saverio Caini
AU - Angelo Cannavicci
AU - Lapo Serni
AU - Oreste Gallo
PY - 2026
DA - 2026/09/25
JO - Cancers
DO - 10.3390/cancers18193113
UR - https://europepmc.org/article/MED/42882808
AB - Background Recurrent oral squamous cell carcinoma (rOSCC) is associated with a poor prognosis, and evidence supporting risk stratification in the salvage setting remains limited. The prognostic value of conventional staging systems and tumor-related characteristics after recurrence has not yet been fully established.Methods We conducted a single-center observational study including patients with rOSCC who had previously undergone treatment for pT1-2 N0M0 OSCC, all subsequently surgically salvaged. Clinical, histopathological, and recurrence-related variables were collected. Recurrent tumors were classified according to the AJCC TNM staging system, the Composite Oral Cavity and Oropharynx Recurrence Staging System (CORSS), and the Same-Up-Down staging system (SUDss), a novel staging system developed by our group.Results A total of 49 patients were included. Several pathological characteristics, including the rT3-4 category (p = 0.025), perineural invasion (p < 0.001), lymphovascular invasion (p = 0.003), greater depth of invasion (p = 0.011), nodal involvement (p = 0.002), and higher rTNM (p = 0.004) and CORSS stage (stage II p = 0.012; stage III p = 0.038) were associated with poorer OS in univariable analyses. In multivariable analysis, CORSS stage II (HR 2.89, 95% CI 1.04-8.04; p = 0.041) and stage III (HR 12.73, 95% CI 2.11-76.68; p = 0.005), as well as close/positive surgical margins (HR 2.57, 95% CI 0.99-6.71; p = 0.045) and pathological nodal involvement (HR 4.82, 95% CI 1.77-13.14; p = 0.002), were independently associated with poorer OS.Conclusions CORSS appears to offer complementary prognostic value compared with conventional rTNM in patients with surgically treated rOSCC, although formal comparative validation of discrimination and calibration is warranted. Pathological lymph node involvement and close or positive surgical margins were the most relevant independent adverse prognostic factors. These findings identify higher-risk patients but do not, by themselves, establish a benefit from treatment intensification.
SN - 2072-6694
ER -