{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:10:51Z","timestamp":1786975851468,"version":"build-2736575974"},"reference-count":15,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2024,2,1]]},"abstract":"<jats:sec id=\"ab-ooi230078-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>The likelihood that an oral cavity lesion harbors occult invasive disease after biopsy demonstrating carcinoma in situ (CIS) is unknown. While de-escalated treatment strategies may be appealing in the setting of CIS, knowing whether occult invasive disease may be present and its association with survival outcomes would lead to more informed management decisions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi230078-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate rate of occult invasive disease and clinical outcomes in patients with oral cavity CIS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi230078-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This was a retrospective population-based cohort study using the National Cancer Database and included adults with biopsy-proven oral cavity CIS as the first diagnosis of cancer between 2004 and 2020. Data were analyzed from October 10, 2022, to June 25, 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi230078-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Surgical resection vs no surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi230078-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Analyses calculated the rate of occult invasive disease identified on resection of a biopsy-proven CIS lesion. Univariate and multivariate logistic regression with odds ratios and 95% CIs were used to identify significant demographic and clinical characteristics associated with risk of occult invasion (age, year of diagnosis, sex, race and ethnicity, oral cavity subsite, and comorbidity status). Kaplan-Meier curves for overall survival (OS) were calculated for both unresected and resected cohorts (stratified by presence of occult invasive disease).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi230078-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 1856 patients with oral cavity CIS were identified, with 122 who did not undergo surgery (median [range] age, 65 [26-90] years; 48 female individuals [39.3%] and 74 male individuals [60.7%]) and 1458 who underwent surgical resection and had documented pathology (median [range] age, 62 [21-90] years; 490 female individuals [33.6%] and 968 male individuals [66.4%]). Of the 1580 patients overall, 52 (3.3%) were Black; 39 (2.5%), Hispanic; 1365 (86.4%), White; and 124 (7.8%), other, not specified. Among those who proceeded with surgery with documented pathology, 408 patients (28.0%) were found to have occult invasive disease. Higher-risk features were present in 45 patients (11.0%) for final margin positivity, 16 patients (3.9%) for lymphovascular invasion, 13 patients (3.2%) for high-grade invasive disease, and 14 patients (3.4%) for nodal involvement. For those patients with occult disease, staging according to the American Joint Committee on Cancer\u2019s\n                      <jats:italic>AJCC Cancer Staging Manual<\/jats:italic>\n                      , eighth edition, was pT1 in 341 patients (83.6%), pT2 in 41 (10.0%), and pT3 or pT4 disease in 26 (6.4%). Factors associated with greater odds of occult invasive disease at resection were female sex, Black race, and alveolar ridge, vestibule, and retromolar subsite. With median 66-month follow-up, 5-year OS was 85.9% in patients who proceeded with surgical resection vs 59.7% in patients who did not undergo surgery (difference, 26.2%; 95% CI, 19.0%-33.4%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi230078-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>This cohort study assessed the risk of concurrent occult invasion with biopsy-proven CIS of the oral cavity, demonstrating that 28.0% had invasive disease at resection. Reassuringly, even in the setting of occult invasion, high-risk disease features were rare, and 5-year OS was nearly 80% with resection. The findings support the practice of definitive resection if feasible following biopsy demonstrating oral cavity CIS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamaoto.2023.3754","type":"journal-article","created":{"date-parts":[[2024,1,4]],"date-time":"2024-01-04T11:32:19Z","timestamp":1704367939000},"page":"151","source":"Crossref","is-referenced-by-count":8,"title":["Rates of Occult Invasive Disease in Patients With Biopsy-Proven Oral Cavity Squamous Cell Carcinoma in Situ"],"prefix":"10.1001","volume":"150","author":[{"given":"Dylan J.","family":"Cooper","sequence":"first","affiliation":[{"name":"Department of Radiation Medicine, Northwell Health Cancer Institute, Zucker School of Medicine at Hofstra\/Northwell, Lake Success, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonah","family":"Ziemba","sequence":"additional","affiliation":[{"name":"Department of Pathology, Northwell Health, Zucker School of Medicine at Hofstra\/Northwell, New 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A.","family":"Miles","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Northwell Health, Zucker School of Medicine at Hofstra\/Northwell, New Hyde Park, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maged","family":"Ghaly","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine, Northwell Health Cancer Institute, Zucker School of Medicine at Hofstra\/Northwell, Lake Success, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nagashree","family":"Seetharamu","sequence":"additional","affiliation":[{"name":"Division of Hematology-Oncology, Northwell Health Cancer Institute, Zucker School of Medicine at Hofstra\/Northwell, New Hyde Park, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Frank","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Northwell Health, Zucker School of Medicine at Hofstra\/Northwell, New Hyde 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