Fluorescence visualization-guided surgery for early-stage oral cancer

Abstract

Importance The prevalence of genetically altered cells in oral cancers has a negative influence on the locoregional recurrence rate and lowers survival. Fluorescence visualization (FV) can identify clinically occult, high-risk oral lesions by allowing health care professionals and surgeons to visualize and map occult disease. This process may improve overall survival by decreasing rates of locoregional recurrence. OBJECTIVE To assess the efficacy of FV-guided surgery in reducing locoregional recurrence and improving overall survival. DESIGN, SETTING, AND PARTICIPANTS A retrospective, case-control observational studywas conducted on patients registered at a single oral oncology clinic from September 1, 2004, to August 31, 2009. The study included 246 patients 18 years or older with a diagnosis of a high-grade lesion (severe dysplasia or carcinoma in situ) or squamous cell carcinoma of less than 4 cmwho underwent curative surgical treatment with at least 1 follow-up visit. Among these patients, 154 underwent surgery with FV guidance (FV group) and the other 92 underwent conventional surgery (control group). Demographic and lesional characteristics and outcomes were collected, and the key factors for the efficacy of FV-guided surgery were examined. Follow-up was completed on December 31, 2011, and data were analyzed from May 1 to November 30, 2013. MAIN OUTCOMES AND MEASURES Local recurrence of oral lesions with a histologic grade of severe dysplasia or higher, the presence of regional failure (ie, ametastatic lesion in the cervical lymph nodes), or disease-free survival after surgery. RESULTS Among the 246 patients included in the study (mean [SD] age, 60 [12] years; 108 women and 138 men), 156 had squamous cell carcinoma and 90 had high-grade lesions. There were no significant differences between the FV (n = 154) and control (n = 92) groups in age, smoking history, anatomical site of the lesion, tumor size, and previous oral cancer. Among the 156 patients with squamous cell carcinoma, the 92 patients in the FV group showed significant reduction in the 3-year local recurrence rate, from 40.6%(26 of 64 patients) to 6.5%(6 of 92 patients) (P