BMC oral health · 2026
Submental island flap reconstruction in the era of neoadjuvant immunochemotherapy: a propensity score-matched cohort study in oral squamous cell carcinoma.
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Du Yajing, Yu Qiongqiong
Аннотация
BACKGROUND: The submental island flap (SIF) is a versatile reconstructive option for oral cavity defects, but concerns regarding recurrences in level I lymph node basins have persisted in the context of neoadjuvant immunochemotherapy (NICT). This study evaluated the clinical outcomes and the incidence of loco-regional recurrences following SIF reconstruction in patients with oral squamous cell carcinoma (OSCC) treated with or without NICT.
METHODS: This retrospective cohort study included 279 patients who underwent SIF reconstruction for OSCC between 2018 and 2024, divided into NICT (n = 135) and upfront surgery (US, n = 144) groups. Propensity score matching (1:1) yielded 85 patients per group with balanced baseline characteristics. Primary outcome was loco-regional recurrence (LRR) analyzed using competing risks regression. Secondary outcomes included overall survival (OS), recurrence patterns, and flap-related complications.
RESULTS: After matching, the NICT group demonstrated significantly less LRR (cumulative incidence 11.8% vs. 30.6%; Gray's test, p = 0.004) and OS (3-year OS 91.8% vs. 85.7%; log-rank p = 0.041). On multivariable analysis, NICT remained an independent protective factor for LRR (adjusted SHR = 0.38; 95% CI: 0.20-0.72; p = 0.003) and OS (adjusted HR = 0.51; 95% CI: 0.27-0.96; p = 0.038). Critically, no recurrences occurred within level I or along the flap subcutaneous tract in either group. Pathological analysis confirmed complete level I lymph node clearance (median yield 7 nodes) with only two NICT patients having positive level I nodes. Flap complication rates were comparable between groups, with no total flap losses.
CONCLUSIONS: In this cohort, SIF reconstruction combined with meticulous level I lymph node clearance was feasible and not associated with observed level I or flap tract recurrences. NICT appears to be associated with significantly improved survival without compromising flap outcomes.
METHODS: This retrospective cohort study included 279 patients who underwent SIF reconstruction for OSCC between 2018 and 2024, divided into NICT (n = 135) and upfront surgery (US, n = 144) groups. Propensity score matching (1:1) yielded 85 patients per group with balanced baseline characteristics. Primary outcome was loco-regional recurrence (LRR) analyzed using competing risks regression. Secondary outcomes included overall survival (OS), recurrence patterns, and flap-related complications.
RESULTS: After matching, the NICT group demonstrated significantly less LRR (cumulative incidence 11.8% vs. 30.6%; Gray's test, p = 0.004) and OS (3-year OS 91.8% vs. 85.7%; log-rank p = 0.041). On multivariable analysis, NICT remained an independent protective factor for LRR (adjusted SHR = 0.38; 95% CI: 0.20-0.72; p = 0.003) and OS (adjusted HR = 0.51; 95% CI: 0.27-0.96; p = 0.038). Critically, no recurrences occurred within level I or along the flap subcutaneous tract in either group. Pathological analysis confirmed complete level I lymph node clearance (median yield 7 nodes) with only two NICT patients having positive level I nodes. Flap complication rates were comparable between groups, with no total flap losses.
CONCLUSIONS: In this cohort, SIF reconstruction combined with meticulous level I lymph node clearance was feasible and not associated with observed level I or flap tract recurrences. NICT appears to be associated with significantly improved survival without compromising flap outcomes.