Limited benefit of surgical resection for oral cavity squamous cell carcinoma in patients with severe comorbidities
In brief
Surgery's survival advantage for oral cancer weakens with severe comorbidity
In a database study of 49,791 patients with oral cavity cancer, definitive radiation was associated with worse overall survival than surgery overall. That difference remained statistically significant in patients with no or mild comorbidity, but not in those with greater comorbidity; the observational findings do not prove treatments are equivalent, and nonoperative options need further study in these patients.
- Journal
- Oral oncology (Q1)
- Published
- 24 September 2026
- Study design
- Unclassified
- Evidence level
- Level 5, Expert Opinion (CEBM 5)
- Authors
- Sohil Singh, Deniz C Demircioglu, Kenneth E Akakpo, Musaddiq Awan
- PMID
- 42785230
- DOI
- 10.1016/j.oraloncology.2026.108153
Why clinicians should know about it
- Picked for Radiation Oncology (paper of the day, 28 September 2026): Definitive radiation vs surgery outcomes OS
Abstract
PURPOSE: Primary surgery is standard for oral squamous cell carcinoma (OSCC) arising from oral cavity sites, but definitive radiation therapy may be considered for select patients. We evaluated whether surgical resection improved outcomes over definitive radiation therapy regardless of comorbidity. METHODS: Adults with invasive, clinically nonmetastatic stage I-IVB OSCC diagnosed from 2010 to 2017 were identified in the National Cancer Database. Primary surgery was defined as surgery to the primary site. Definitive radiation therapy was defined as no primary-site surgery and a total radiation dose of at least 6,600 cGy; this nonsurgical treatment group included patients treated with definitive radiation alone, definitive chemoradiation, or definitive radiation with non-chemotherapy systemic therapy. Overall survival was compared using multivariable Cox models and subgroup-specific propensity-score overlap-weighted Cox models by age group and Charlson-Deyo Comorbidity Classification (CDCC). RESULTS: The cohort included 49,791 patients; 46,778 underwent primary surgery and 3,013 received definitive radiation therapy. Definitive radiation therapy was associated with worse survival in multivariable analysis (HR, 1.395; 95% CI, 1.326-1.469; p < 0.001) and full-cohort overlap-weighted analysis (HR, 1.397; 95% CI, 1.326-1.471; p < 0.001). In CDCC-stratified analyses, the association favoring primary surgery remained significant for CDCC 0 and CDCC 1 but no longer statistically significant for CDCC 2 and CDCC ≥ 3. Formal interaction testing demonstrated variation by age and CDCC. CONCLUSION: Definitive radiation therapy was associated with worse overall survival compared with primary surgery in OSCC. However, the survival disadvantage appeared attenuated among patients with higher comorbidity burden, supporting further evaluation of nonoperative strategies in selected patients with substantial comorbidity.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.