Over a quarter of a million cases of oral squamous cell carcinomas (SCC) are diagnosed annually worldwide with 128,000 registered deaths. In spite of much-improved anaesthetic and surgical techniques, survival rates have not improved much over the past three decades. One of the main reasons for this is recurrence, be that local, regional or distal. For early-stage disease recurrence locally or new primaries in an area of field change are a leading source of death while in later stages up to 37% patients suffer a loco regional recurrence. A well-known statistic is that five-year survival goes down from 90% to 30% once recurrence is diagnosed. It is not always clear all the factors that influence recurrence and current interest is on biological markers. The authors are from a single institution in Germany and have conducted a retrospective audit of 517 patients with oral SCC from 2003-2013. Recurrence was diagnosed in 13.3% of patients. The authors found a significant correlation between recurrence and number of resected nodes, positive nodal disease numbers, postoperative radiation, extracapsular spread and grading. They identify poorly differentiated oral SCC as an independent risk factor for recurrence and even quantify the risk as being two-fold of well or moderately differentiated tumours. Another interesting association is postoperative radiation. Whereas postoperative radiotherapy is usually given for patients with locally advanced disease in this study they confirm a higher rate of recurrence and suggest as an explanation radiation causing DNA damage locally. Vascular invasion and particularly lymphatic vessel invasion is an accepted risk factor and yet in this study, there are no significant associations. The authors suggest this might be due to the smaller size of the study. This is an excellent paper that is well worth reading to understand the current discussion on risk factors for oral SCC recurrence. 

Analysis of clinicopathological risk factors for locoregional recurrence of oral squamous cell carcinoma-retrospective analysis of 517 patients.
Safi A, Kauke M, Grandoch A, et al.
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Sunil K Bhatia

Royal Shrewsbury Hospital, Shrewsbury, UK.

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