Definitive intensity-modulated radiotherapy or surgery for early oral cavity squamous cell carcinoma: Propensity-score-matched, nationwide, population-based cohort study

Background: No evidence is currently available to estimate the outcomes of intensity-modulated radiation therapy (IMRT) and surgery for patients with early oral cavity squamous cell carcinoma (E-OCSCC). Methods: We recruited patients from the Taiwan Cancer Registry Database who had received a diagnosis of E-OCSCC. Propensity score matching was performed, and Cox proportional hazards model was used to analyze all-cause mortality. Results: In the multivariate Cox regression analyses, the adjusted hazard ratio (aHR) (95% confidence interval [CI]) for surgery compared with definitive IMRT, T2N0M0 compared with T1N0M0, and male patients compared with female patients were 0.303 (0.245, 0.375), 1.340 (1.077, 1.668), and 2.012 (1.432, 2.826), respectively. The aHRs (95% CIs) for age 61 to 70, 71 to 80, and ≧81 years compared with <40 years were 2.984 (1.43, 4.225), 3.353 (2.578, 4.112), and 4.277 (4.104, 5.679), respectively. Conclusions: For patients with E-OCSCC, surgery may be considered the first option rather than definitive IMRT.