3548 - Impact of Younger Age on Clinicopathologic Presentation and Oncologic Outcomes in Oral Tongue Squamous Cell Carcinoma
Presenter(s)
B. Lopez1, E. Palaganas2, A. Beighley2, S. Iganej3, and O. Bhattasali3; 1Charles R. Drew University of Medicine and Science, Los Angeles, CA, 2Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, 3Southern California Permanente Medical Group, Los Angeles, CA
Purpose/Objective(s): Younger patients with oral tongue squamous cell carcinoma (OTSCC) typically represent a biologically distinct population without classical risk factors and may respond differently to conventional treatment approaches. We evaluated the impact of younger age on clinicopathologic presentation and oncologic outcomes in OTSCC.
Materials/Methods: We performed a retrospective review of 525 OTSCC patients treated with curative intent with oncologic resection with or without adjuvant therapy within an integrated health care system from 2015 to 2024. Younger patients were defined as age <45 years (n=67). Clinicopathologic factors were compared using Chi-square test. Locoregional failure (LRF), disease-free survival (DFS), and overall survival (OS) were estimated by the Kaplan-Meier method with 3-year outcomes reported. Cox proportional hazard models were used to compare groups.
Results: Median follow-up for surviving patients was 4.9 years. Younger patients were more likely to be never smokers (76% vs. 56%, p=0.002) and have advanced nodal disease (N2-N3) (31% vs. 17%, p=0.01) and perineural invasion (42% vs. 31%, p=0.03). There were trends toward higher rates of extranodal extension (ENE) (16% vs. 9%, p=0.06) and more advanced TNM stage (I: 30% vs. 39%; II: 28% vs. 22%; III: 9% vs. 17%; IV: 33% vs. 22%, p=0.06) in younger patients compared to older patients, respectively. No differences were observed by patient sex, T stage, or presence of lymphovascular invasion. In patients who underwent adjuvant radiotherapy, there was a trend toward increased use of concurrent chemotherapy in the absence of absolute indications (ENE or positive margins) in younger patients (40% vs. 23%, p=0.07).
For the entire cohort, 3-year LRF, DFS, and OS were 19%, 75%, and 81%, respectively. Younger age was not associated with LRF (22% vs. 18%, p=0.57), DFS (75% vs. 75%, p=0.26), or OS (82% vs. 78%, p=0.29) when compared to older patients, respectively. TNM stage III-IV was associated with higher rates of LRF (13% vs 28%, p<0.001) and inferior DFS (84% vs. 61%, p<0.001) and OS (92% vs. 65%, p<0.001). In TNM stage I-II disease, comparing younger patients vs. older patients, no difference was observed in LRF (18% vs. 12%, p=0.54), DFS (82% vs. 84%, p=0.27), or OS (90% vs. 92%, p=0.14); similarly, in TNM stage III-IV disease, no difference was observed in LRF (29% vs. 28%, p=0.88), DFS (64% vs. 60%, p=0.64), or OS (58% vs. 65%, p=0.86).Conclusion: In patients with OTSCC treated with curative intent, younger patients did not experience inferior disease control or survival, despite harboring more adverse pathologic factors. This could be due, in part, to a non-significant increased utilization of concurrent chemotherapy during adjuvant radiotherapy in younger patients. Prospective investigation is warranted to understand the benefit of treatment intensification in young patients with OTSCC.