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Damazo BJ, Punjabi NA, Liu YF, Inman JC. Histopathologic predictors of recurrence and survival in early T stage oral tongue squamous cell carcinoma. FRONTIERS IN ORAL HEALTH 2024; 5:1426709. [PMID: 39165677 PMCID: PMC11333445 DOI: 10.3389/froh.2024.1426709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 07/25/2024] [Indexed: 08/22/2024] Open
Abstract
Objectives Recurrence and survival in early T-stage oral tongue squamous cell carcinoma (OTSCC) may be impacted by histopathologic risk factors. This study aims to examine which of these factors predict long-term outcomes of T1 and T2 OTSCC. Methods A retrospective review of T1 and T2 OTSCC patients treated with surgery at a single tertiary care center was conducted. Multivariate regression and Kaplan-Meier survival plots were used to identify predictors of recurrence and compare disease-free survival respectively. Results 100 consecutive patients were studied. Of these, 51 were staged pT1, 49 pT2, 69 pN0, 10 pN1, and 21 pN2. Multivariate regression analysis revealed that >4 nodes was the strongest predictor of overall recurrence [odds ratio 1.68 (1.23-2.28), p = 0.001], while >4 nodes [odds ratio 1.14 (1.09-1.85), p = 0.008] and pT2 [odds ratio 1.15 (1.01-1.30), p = 0.033] were predictors of local recurrence (R2 = 0.112). Five-year disease-free survival was not significantly impacted by any risk factors except for the number of positive nodes-86% for ≤4 nodes vs. 20% for >4 nodes (p < 0.001)-and pathologic T-stage-90% for pT1 vs. 75% for pT2 (p = 0.035) regardless of adjuvant radiation and/or chemotherapy use. Conclusions Patients who underwent adjuvant radiation and/or chemotherapy had similar survival to those who did not despite having worse overall tumor prognostic factors. Adding adjuvant therapy may equalize some high-risk histopathologic factors. In the highest risk patients-specifically those with pathologic >4 nodes and pT2 staging-adjuvant therapy should be considered.
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Affiliation(s)
- Benjamin J. Damazo
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, United States
| | - Nihal A. Punjabi
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, United States
- Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Yuan F. Liu
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, United States
| | - Jared C. Inman
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, United States
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Giresh A, Parida PK, Chappity P, Adhya AK, Nayak A, Pradhan P, Sarkar S, Samal DK. Prevalence of Skip Metastases to Cervical Lymph-Nodes in Oral cavity Cancer in Eastern India-an observational study. Indian J Otolaryngol Head Neck Surg 2022; 74:6374-6383. [PMID: 36742498 PMCID: PMC9895623 DOI: 10.1007/s12070-021-03048-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 12/27/2021] [Indexed: 02/07/2023] Open
Abstract
To determine the prevalence of skip metastases in Oral-squamous-cell-carcinoma (OSCC). This prospective observational study was carried out on 100-cases of biopsy proven OSCC who underwent surgical treatment for the primary tumor along with neck dissection (ND). Data regarding depth of invasion (DOI) by primary tumor, perineural-invasion, lymphovascular-invasion, presence of metastatic-lymph-node (level, size, number and extranodal-extension) were collected from histopathology reports and were analyzed. Out of 100-cases, 73-were-male and 27-were-female. Mean age was 49.5 ± 12.3 years (range 24-4 years). Common subsites of tumor were buccal-mucosa, tongue and lower-alveolus in 40, 37 and 14% respectively. Pathological staging of tumor were stage-I, stage-II, stage-III, stage-IVa and stage-IVb in 22, 14, 25, 22 and 15% cases respectively. Preoperative neck staging was cN0 in 50 necks (47.2%) and cN+ in 56 necks (52.8%). In 100-patients 106-NDs (unilateral-94 and bilateral-6) were performed. Type of NDs were Supraomohyoid, extended-Supraomohyoid and modified radical neck-dissection in 23,07and76 cases respectively. Prevalence of cervical lymph node metastases was 36% (pN + necks). Among 36pN + patients; 25 (69.4%) cases, 20 (55.5%) cases, 9 (25%) cases, 4 (11.1%) cases, 2 (5.5%) cases had metastases to level-I, II, III, IV and V respectively. Skip-metastases was present in four-cases {level-IIb:one-case (2.78%), level-III: two-cases (5.5%) and level-V:one-case (2.78%)}. No-skip-metastasis to level-IV was noticed. All-four-cases of skip-metastases were from advance cases of squamous-cell-carcinoma of tongue with DOI > 5 mm. Skip-metastases to levels IIb, IV and V are uncommon in cases of OSCC. Most of the metastasis in our study was noted to levels I, II and III in a predictable fashion. Thus, extensive ND can be avoided in patients to prevent complications and morbidities associated with the same.
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Affiliation(s)
- Anupama Giresh
- Department of Ear, Nose, Throat and Head Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha India
| | - Pradipta Kumar Parida
- Department of Ear, Nose, Throat and Head Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha India
| | - Preetam Chappity
- Department of Ear, Nose, Throat and Head Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha India
| | - Amit Kumar Adhya
- Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, Odisha India
| | - Anindya Nayak
- Department of Ear, Nose, Throat and Head Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha India
| | - Pradeep Pradhan
- Department of Ear, Nose, Throat and Head Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha India
| | - Saurav Sarkar
- Department of Ear, Nose, Throat and Head Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha India
| | - Dillip Kumar Samal
- Department of Ear, Nose, Throat and Head Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha India
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Altuwaijri AA, Aldrees TM, Alessa MA. Prevalence of Metastasis and Involvement of Level IV and V in Oral Squamous Cell Carcinoma: A Systematic Review. Cureus 2021; 13:e20255. [PMID: 35018258 PMCID: PMC8738916 DOI: 10.7759/cureus.20255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 12/02/2022] Open
Abstract
The occurrence of occult metastases in oral cavity squamous cell carcinoma (OSCC) to lower levels in the neck (levels IV and V) or development of skip metastases that bypass the upper neck levels (levels I to III) and go directly to level IV or V is common. This challenges the efficacy of conventional neck dissection approaches in the treatment of OSCC. Therefore, the decision to include lower levels cervical nodes during elective neck dissection of OSCC remains controversial. This systematic review was designed to assess the prevalence of level IV and/or V involvement or skip metastases in patients with the clinically negative neck (cN0) or positive (cN+) oral squamous cell carcinoma (OSCC). We searched for studies published between December 2000 and December 2020. Potentially relevant abstracts and full-text articles were screened, and data from the studies were extracted. Quality was rated using the Newcastle Ottawa Scale (NOS) criteria. In total, 802 abstracts and 227 full-text articles were screened, and 32 studies were included in this analysis. The prevalence of metastasis ranged from 1.8% to 66.0%. The incidence for skip metastasis to level IV or V was low, reaching 8.5%. Evidence favored elective neck dissection, including levels I to III, in selected patients with OSCC and patients with cN0 or cN+ neck. The literature was non-conclusive on the recommendation for inclusion of lower levels.
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Affiliation(s)
- Ahmad A Altuwaijri
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, SAU
- Department of Otolaryngology-Head and Neck Surgery, Security Forces Hospital, Riyadh, SAU
| | - Turki M Aldrees
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Alkharj, SAU
| | - Mohammed A Alessa
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, SAU
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Kwak MS, Eun YG, Lee JW, Lee YC. Development of a machine learning model for the prediction of nodal metastasis in early T classification oral squamous cell carcinoma: SEER-based population study. Head Neck 2021; 43:2316-2324. [PMID: 33792112 DOI: 10.1002/hed.26700] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 03/01/2021] [Accepted: 03/16/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND This study aimed to develop and compare machine learning (ML) based predictive models for lymph node metastasis (LNM) in early T classification oral squamous cell carcinoma (OSCC). METHODS We used data from the Surveillance Epidemiology and End Results Database to develop and validate the predictive models for LNM in patients with T1, T2 OSCC. Using simple clinical and histopathological data, we developed six ML algorithms to predict LNM. The predictive performance of models was compared. RESULTS The areas under the receiver operating characteristic curves (AUCs) of the six models ranged from 0.768 to 0.956. The best prediction performance was achieved with a XGBoost (AUC = 0.956). Permutation importance analysis showed that tumor size is the most important feature in predicting metastasis. CONCLUSIONS We developed a simplified and reproducible ML-based predictive model for metastasis in early T classification OSCC that could be helpful for the decision of a treatment strategy.
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Affiliation(s)
- Min Seob Kwak
- Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Young-Gyu Eun
- Department of Otolaryngology - Head and Neck surgery, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Jung-Woo Lee
- Department of Oral & Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, South Korea
| | - Young Chan Lee
- Department of Otolaryngology - Head and Neck surgery, School of Medicine, Kyung Hee University, Seoul, South Korea
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Impact of lymphovascular invasion in oral squamous cell carcinoma: A meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:319-328.e1. [PMID: 33309267 DOI: 10.1016/j.oooo.2020.10.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 10/21/2020] [Accepted: 10/26/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Lymphovascular invasion (LVI) has been reported as a predictor of prognosis in multiple cancers. The aim of this meta-analysis was to investigate the potential value of LVI as a prognostic predictor of oral squamous cell carcinoma (OSCC). STUDY DESIGN To identify relevant studies, PubMed, Embase, Web of Science, and Cochrane Library database were searched from inception to October 2020. All studies exploring the association of LVI with overall survival (OS), disease-specific survival (DSS), or disease-free survival (DFS) and lymph node metastasis (LNM) were identified. RESULT Pooled odds ratios for LNM and hazard ratios for survival were calculated using fixed effects or random effects models. Thirty-six studies involving 17,109 patients with OSCC were included and further analyzed. The results showed that positive LVI was significantly associated with LNM and worse survival in patients with OSCC. Moreover, positive LVI was correlated with LNM in patients with early stage OSCC. CONCLUSIONS These findings indicate that LVI may serve as a prognostic predictor for the metastasis and prognosis of OSCC and could be considered a routine pathologic examination in clinical work.
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Weisz Shabtay N, Ronen O. Level IV neck dissection as an elective treatment for oral tongue carcinoma-a systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:363-372. [PMID: 32540318 DOI: 10.1016/j.oooo.2020.04.810] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 01/27/2020] [Accepted: 04/21/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The purpose of our systematic review was to investigate the prevalence of level IV involvement and skip metastases in patients with clinically negative neck (cN0) oral tongue squamous cell carcinoma (OTSCC). The occurrence of occult metastases to lower levels in the neck (levels IV and V) or the development of an erratic distribution of cervical metastases ("skip metastases") that bypass the upper neck levels (levels I to III) and go directly to level IV or V challenges the role of supraomohyoid neck dissection in the treatment of OTSCC; therefore, controversy exists over including level IV cervical nodes during an elective neck dissection of OTSCC. STUDY DESIGN Our search included all studies published from 1989 until January 2018 in the Cochrane Library, PubMed, EMBASE, and Web of Science. Abstracts and full-text articles that were deemed potentially relevant were screened. Data from the studies were extracted by using standardized tables, and a meta-analysis was conducted. RESULTS In total, 3000 abstracts and 269 full text articles were screened, and 11 studies were included in this analysis. Among the 498 patients included, 16 had level IV involvement, representing involvement of 2.8%. The incidence for skip metastasis to level IV was low as well. CONCLUSIONS We recommend elective neck dissection that includes levels I to III in selected patients with OTSCC and cN0 neck.
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Affiliation(s)
| | - Ohad Ronen
- Department of Otolaryngology Head and Neck Surgery, Galilee Medical Center, affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
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7
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Warshavsky A, Rosen R, Nard-Carmel N, Abu-Ghanem S, Oestreicher-Kedem Y, Abergel A, Fliss DM, Horowitz G. Assessment of the Rate of Skip Metastasis to Neck Level IV in Patients With Clinically Node-Negative Neck Oral Cavity Squamous Cell Carcinoma: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2020; 145:542-548. [PMID: 31070693 DOI: 10.1001/jamaoto.2019.0784] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance The rate of skip metastasis to neck level IV in patients with clinically node-negative neck (cN0) oral cavity squamous cell carcinoma (OCSCC) remains controversial. Objective To provide a high level of evidence using a meta-analysis on the rate of skip metastasis to level IV in this subset of patients. Data Sources The Embase, PubMed, and Google Scholar databases were searched for articles published during the period of January 1, 1970, through December 31, 2017, using the following key terms: neck dissection, N0 neck, squamous cell carcinoma, skip metastasis, radical neck dissection, lymph node management, neck metastasis, oral cavity cancer, and tongue cancer. Some terms were also used in combination, and the reference section of each article was searched for additional potentially relevant publications. Data were analyzed from January 8 through 11, 2018. Study Selection Inclusion criteria were all cohorts, including from any randomized clinical trial, case-control study, case study, and case report; studies of patients with the histopathologic diagnosis of OCSCC; and studies that differentiated data between skip metastasis and sequential metastasis to neck level IV. Of the 115 articles retrieved from the literature, 11 retrospective studies and 2 prospective randomized clinical trials (n = 1359 patients) were included. Data Extraction and Synthesis Meta-analysis of Observational Studies in Epidemiology guidelines were followed. Fixed-effects model and 95% CIs were estimated, and data of included studies were pooled using a fixed-effects model. Main Outcomes and Measures Overall proportion of neck involvement and the rate of level IV skip metastasis. Subgroup analysis for primary site and tumor staging. Results The rate of level IV involvement in patients with cN0 ranged between 0% and 11.40% with a fixed-effects model of 2.53% (95% CI, 1.64%-3.55%). The rate of skip metastasis ranged from 0% to 5.50% with a fixed-effects model of 0.50% (95% CI, 0.09%-1.11%). The rate of level IV skip metastasis did not increase significantly in cases that involved neck levels I through III. Tumor staging and primary site tumor did not significantly affect the rate of skip metastasis. Conclusions and Relevance This meta-analysis showed very low rates of skip metastasis to neck level IV in patients diagnosed with cN0 OCSCC. Encountering an allegedly positive lymph node during neck dissection does not portend high rates of level IV involvement. Supraomohyoid neck dissection is therefore adequate for this subset of patients.
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Affiliation(s)
- Anton Warshavsky
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roni Rosen
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Narin Nard-Carmel
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sara Abu-Ghanem
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Oestreicher-Kedem
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avraham Abergel
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan M Fliss
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Horowitz
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Hu Z, Yang R, Li L, Mao L, Liu S, Qiao S, Ren G, Hu J. Validation of Gene Profiles for Analysis of Regional Lymphatic Metastases in Head and Neck Squamous Cell Carcinoma. Front Mol Biosci 2020; 7:3. [PMID: 32118031 PMCID: PMC7010860 DOI: 10.3389/fmolb.2020.00003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 01/10/2020] [Indexed: 12/24/2022] Open
Abstract
The progress of Head and Neck Squamous Cell Carcinoma (HNSCC) is dependent on both cancer stem cells (CSCs) and immune suppression. This study was designed to evaluate the distribution of CSCs and the characteristic immune suppression status in HNSCC primary tumors and lymph nodes. A total of 303 lymph nodes from 25 patients, as well as tumor and adjacent normal tissue samples, were evaluated by a quantitative PCR assay of the markers of CSCs and the characteristic immune suppression. Expressions of selected genes in The Cancer Genome Atlas (TCGA) datasets were also analyzed. In the primary tumors, we found that expressions of CSCs markers (ALDH1L1, PECAM1, PROM1) were down-regulated, while immune suppression markers FOXP3, CD47, EGFR, SOX2, and TGFB1 were up-regulated significantly when compared to that in adjacent normal tissues. In the lymph nodes, expressions of both CSCs, and immune suppression markers were upregulated significantly compared with that in primary tumors. The mRNA expression of selected CSCs and immune suppression markers exhibited the highest expression in the level II of metastasis, then declined in the level III and remained constant at a reduced value in levels IV and V of metastases. These results reveal a comprehensive understanding of the unique genetic characteristics associated with metastatic loci and potential routes of lymphatic dissemination of HNSCC, which helps to explain why the level II has a high incidence of lymph node metastasis, and why skip metastasis straight to the level IV or level V is rarely found in the clinic.
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Affiliation(s)
- Zhenrong Hu
- School of Stomatology, Weifang Medical University, Weifang, China.,Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ranran Yang
- School of Stomatology, Weifang Medical University, Weifang, China.,Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Li
- Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu Mao
- School of Stomatology, Weifang Medical University, Weifang, China.,Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuli Liu
- Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.,National Clinical Research Center of Stomatology, Shanghai, China
| | - Shichong Qiao
- Shanghai Key Laboratory of Stomatology, Department of Oral and Maxillo-facial Implantology, School of Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Guoxin Ren
- School of Stomatology, Weifang Medical University, Weifang, China.,Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.,National Clinical Research Center of Stomatology, Shanghai, China
| | - Jingzhou Hu
- School of Stomatology, Weifang Medical University, Weifang, China.,Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.,National Clinical Research Center of Stomatology, Shanghai, China
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Is skip metastases associated with tumor thickness and tumor size in tongue carcinoma patients? Clin Oral Investig 2018; 23:2071-2075. [PMID: 30238418 DOI: 10.1007/s00784-018-2589-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 08/17/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To assess the correlation of skip metastases associated with increase in tumor thickness and size of the tumor. MATERIAL AND METHODS A retrospective analysis was carried out from August 2009 to August 2015. In this study, a total number of 33 carcinoma tongue patients having T1, T2, and T3 sizes with N0 and N+ clinical necks who were treated by supraomohyoid neck dissection, extended supraomohyoid neck dissection, and modified radical neck dissection were analyzed. The data was assessed using Shapiro-Wilk W test, Nagelkerke R2 regression model, mean, and standard deviation. RESULTS Metastasis to lymph nodes was present in 75% of patients. Level I and level II were the commonest sites to be involved, i.e., 20 patients. Three patients had skip metastasis out of which two patients had metastasis at level III (6%), and one patient had skip metastasis at level IV (3%). CONCLUSION The incidence of skip metastasis increases with tumor thickness and tumor size in tongue carcinoma patients. CLINICAL RELEVANCE The article reveals the positive relationship between tumor thickness, tumor size, and skip metastasis. The analysis shows tumor thickness as a higher predictor for skip metastasis with odds ratio of 5.5 compared to the tumor size having odd ratio 2.
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10
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Mair M, Nair D, Nair S, Malik A, Mishra A, Kannan S, Bobdey S, Singhvi H, Chaturvedi P. Comparison of tumor volume, thickness, and T classification as predictors of outcomes in surgically treated squamous cell carcinoma of the oral tongue. Head Neck 2018; 40:1667-1675. [PMID: 29734474 DOI: 10.1002/hed.25161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 09/13/2017] [Accepted: 02/05/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND As per TNM classification, superficial tumors with a favorable prognosis are fallaciously clubbed together with unfavorable, deeply infiltrating lesions in the same classification. METHODS This is a retrospective study of 588 patients with treatment-naive oral tongue cancers. Binary logistic regression was used to identify predictors of nodal metastasis and extracapsular spread (ECS) using tumor volume and thickness as separate models. The C-index was generated to quantify predictive accuracy of T classification, thickness, and tumor volume for survival. RESULTS Compared to T classification, tumor volume and thickness were better predictors of nodal metastasis and ECS. Predictive accuracy for disease-free survival (DFS) and overall survival (OS) given by C-index was equal and better for thickness (0.60 and 0.69) and tumor volume (0.61 and 0.69) as compared to T classification (0.59 and 0.64, respectively). For early-stage T1 to T2 oral tongue cancer, thickness is a better predictor of nodal metastasis as compared to tumor volume and T classification. CONCLUSION Concordance between the tumor thickness and volume proves that tumor thickness can be taken as a surrogate and reliable predictor of outcomes instead of calculating the tumor volume.
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Affiliation(s)
- Manish Mair
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Deepa Nair
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Sudhir Nair
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Akshat Malik
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Aseem Mishra
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Sadhana Kannan
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Saurabh Bobdey
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, India
| | - Hitesh Singhvi
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
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11
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The Latest Advancements in Selective Neck Dissection for Early Stage Oral Squamous Cell Carcinoma. Curr Treat Options Oncol 2017; 18:31. [PMID: 28474264 DOI: 10.1007/s11864-017-0471-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OPINION STATEMENT The management of cervical lymph node metastasis remains a crucial component of the treatment of head and neck cancers. However, the proper management of clinical N 0 cases with early-stage oral squamous cell carcinoma (OSCC) remains undefined. In the advent of minimally invasive techniques in the 1980s, these techniques have gained popularity among numerous surgeons in all fields of surgery. Although there are no randomized controlled trial data comparing the outcomes of minimally invasive techniques (endoscopically assisted selective neck dissection (SND), robot-assisted SND) with conventional techniques, encouraging evidence from several studies suggests that both endoscopically assisted SND and robot-assisted SND are safe, minimally invasive techniques with achieved short-term oncologic outcomes and can reach a better cosmetic outcome than conventional SND. In this review, we also compare the indications, surgical approaches, and relative advantages and disadvantages of conventional SND, endoscopically assisted SND, and robot-assisted SND to provide surgeons with a means to better consider these techniques for the treatment of early-stage OSCC.
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Cervical Metastases Behavior of T1-2 Squamous Cell Carcinoma of the Tongue. J Maxillofac Oral Surg 2016; 16:300-305. [PMID: 28717287 DOI: 10.1007/s12663-016-0936-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 06/17/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION The cervical lymph node metastasis (CM) is one of the most important prognostic factors for oral squamous cell carcinoma. Although the frequency and distribution of CM for tongue carcinoma (TC) are well documented in the literature, there is only little data on metastasis patterns depending on the location of the cancer within the tongue. MATERIALS AND METHODS In a retrospective study all patients with a T1-T2 TC who were treated between 1997 and 2013 were analysed regarding epidemiological data, risk factors, and tumour parameters such as exact localization, CM. RESULTS 204 patients (59 ± 15 years; ♀37 %, ♂63 %) were included. At the initial diagnosis 23 % had an advanced tumour stage (III-IV) due to CM. The occurrence of CM was significantly higher for T2, advanced G-status and the localization in the posterior area of the tongue. The presence of CM-but not the recurrence-had a significant influence on the survival rate. CONCLUSION The small TC has an aggressive metastatic behaviour depending not only on the classical prognostic factors such as grading and tumour size, but is also strongly influenced by the posterior location within the tongue.
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