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Our previous phase 3 trial (NCT01542931) failed to demonstrate improved survival when docetaxel, cisplatin and 5-fluorouracil (TPF) induction chemotherapy was introduced prior to surgery and postoperative radiotherapy in patients with locally advanced oral squamous cell carcinoma (OSCC). The aim of the present study was to investigate the long-term predictive value of GDF15 expression for potential personalized treatment strategies in OSCC. A total of 256 patients with stage III/IVA OSCC from our phase 3 trial were enrolled in the present study. Immunohistochemical staining against GDF15 was performed in the biopsy samples from 230/256 patients. Kaplan-Meier analysis, followed by the log-rank test, and the Cox proportional hazards model were used for outcome analysis using the statistical SPSS 18.0 software package for Windows. Among the 230 patients, low GDF15 expression was detected in 68 patients and high GDF15 expression was detected in 162 patients. With a median follow-up period of 67 months, the patients with low GDF15 expression exhibited a higher survival rate than those with high GDF15 expression, including 5-year overall survival (73.4 vs. 57.7%; P=0.059), 5-year disease-free survival (64.5 vs. 49.2%; P=0.033), 5-year locoregional recurrence-free survival (66.0 vs. 51.5%; P=0.043) and 5-year distant metastasis-free survival (73.4 vs. 56.6%; P=0.038) rates. Furthermore, the cT3/4N0M0 patients with high GDF15 expression benefited significantly from TPF induction chemotherapy, including overall survival (HR=0.233; P=0.02), disease-free survival (HR=0.296; P=0.014), locoregional recurrence-free survival (HR=0.347; P=0.035) and distant metastasis-free survival (HR=0.212; P=0.013) rates. The results of the present study suggested that elevated GDF15 expression may be used as a long-term prognostic biomarker for poor clinical outcomes in patients with locally advanced OSCC. Elevated GDF15 expression in cT3/4N0M0 patients predicts significant long-term benefit of survival from TPF induction chemotherapy. [ABSTRACT FROM AUTHOR]

PURPOSE: This study aims to investigate the correlation between the thickness of the tongue carcinoma and cervical lymph node metastasis obtained with ultrasonography. METHODS: The tumor thickness of 37 primary tongue cancers were measured in the sonogram by the intraoral ultrasonography. The cervical lymph nodes were scanned, and the number, size, internal echo, and blood stream were measured to evaluate the nature. SAS6.1 software package was used for Chi-square test, non-parametric test and Logistic regression. RESULTS: The tumor thickness measured before operation with ultrasonngraphy and after operation from pathological sections was subjected to non-parameter Wilcox rank-sum test. P=0.2013, indicating that there was no significant difference between the mean thickness obtained from the two modalities. The tumor thickness and cervical lymph node metastasis were subjected to non-parameter rank correlation test, the Spearman r=0.6824,P<0.01, indicating that there were a positive correlation between the tumor thickness measured by ultrasonography scan and cervical lymph node metastasis. Logistic regression analysis also showed that the risk of metastasis of the neck lymph nodes increased with the increased thickness of the tumors. CONCLUSIONS: The accuracy and sensitiveness of ultrasonography in measuring the tumor thickness and detection of cervical lymph metastases make it a promising pre-operative tool in staging the cancer and optimizing the treatment plan for the surgeons. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate induction chemotherapy with docetaxel, cisplatin and 5-fluorouracil (TPF) followed by surgery and post-operative radiotherapy versus upfront surgery and post-operative radiotherapy in patients with locally advanced, resectable oral squamous cell carcinoma (OSCC). Patients and methods: A prospective, open label, phase III trial was conducted. Eligibility criteria included untreated, stage III or IVA locally advanced, resectable OSCC. Patients received two cycles of TPF induction chemotherapy (75mg/m2 docetaxel d1, 75mg/m2 cisplatin d1, and 750mg/m2 5-fluorouracil d1-5) followed by radical surgery and post-operative radiotherapy (54–66Gy), versus upfront radical surgery and post-operative radiotherapy. The primary endpoint was overall survival. Secondary endpoints included local control and safety. Results: 256 patients were enrolled in this trial and 222 patients completed the full treatment protocol. There were no unexpected toxicities and induction chemotherapy did not increase peri-operative morbidity. The clinical response rate to induction chemotherapy was 80.6%. After a median follow-up of 30months, there was no significant difference in overall survival (HR=0.977, 95% CI 0.634–1.507, p =0.918) and disease-free survival (HR=0.974, 95% CI 0.654–1.45, p =0.897) between the patients treated with and without TPF induction (Fig. 1). Patients in the induction chemotherapy arm with a clinical response or favorable pathologic response (10% or less viable tumor cells) had superior overall survival, locoregional and distant control (Fig. 2). Conclusion: Our study failed to demonstrate that TPF induction chemotherapy improves survival compared to surgery upfront in patients with resectable stage III and IVA OSCC. [Copyright &y& Elsevier]