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Predictive modelling of level IIb lymph node metastasis in oral squamous cell carcinoma. Sci Rep 2021; 11:17562. [PMID: 34475441 PMCID: PMC8413325 DOI: 10.1038/s41598-021-96827-1] [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] [Received: 06/11/2021] [Accepted: 08/12/2021] [Indexed: 02/07/2023] Open
Abstract
The aim of the present study was to examine the conditions, characteristics, and risk factors of level IIb lymph node metastases in oral squamous cell carcinoma and to formulate surgical criteria for level IIb lymph node dissection. We analyzed clinical and pathological records for 541 oral squamous carcinoma patients in relation to level IIb metastasis. Univariate and multivariate analyses were performed to detect risk factors for level IIb lymph node metastasis; a predictive model was built based on multivariate analysis and tested in a validation group. Univariate and multivariate analyses using the training group indicated that level IIa metastasis and Lymphovascular permeation (LVP) were two independent risk factors for level IIb lymph node metastasis. This model was built and tested in a validation group, the area under the curve being 0.697 (P < .0.001). The model's sensitivity was 66.7% and specificity was 77.4%. Nomogram incorporating validated variables was developed for level IIb metastasis prediction. Expected survival probabilites were analysed to specify significance of model's variable on patients' overall survival and recurrence. Level IIb dissection should be performed in patients with level IIa metastasis and LVP. However, thorough consideration of the oncologic safety of omitting level IIb dissection is compulsory.
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Jayasuriya NSS, Mannapperuma NT, Siriwardana S, Attygalla AM, DeSilva S, Jinadasa H, Ekanayaka R, Dias DK, Wadusinghearachi S, Perera I. Incidence of metastasis to level V lymph nodes in clinically positive necks among Sri Lankan patients with oral squamous cell carcinoma. Br J Oral Maxillofac Surg 2020; 59:771-775. [PMID: 34127322 DOI: 10.1016/j.bjoms.2020.09.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
Oral squamous cell carcinoma (OSCC) remains the most common cancer among males in Sri Lanka. Metastasis to neck is a crucial prognostic factor. A modified radical/radical neck dissection including levels I -V, was performed in patients with OSCC who had a clinically positive neck (cN+). Currently, evidence suggests that sparing level V in a cN+ may be justified due to less chance of metastasis in early stages of the disease. To the best of our knowledge, the incidence of metastasis to level V in patients with cN+s has not been previously investigated in a Sri Lankan context. We aimed to determine level V lymph node metastasis and related clinicopathological indicators in cN+s in patients with OSCC. A multicentre retrospective study investigated postoperative biopsy reports of 187 patients for five years. OSCC patients with cN+s who underwent neck dissections of levels I-V were included. Only 6.4% of patients had histopathologically positive level V lymph nodes. A total of 127 lymph nodes were harvested from level V of those who showed level V positivity and out of them 68 were positive with a third of cases showing extranodal extension (ENE). The buccal mucosa (n=4) and lateral aspect of the anterior two thirds of the tongue (n=4) were the common primary sites for level V metastasis. In patients who showed positivity in levels III and IV, a considerably higher probability of level V nodes being positive was seen, which was statistically significant (p = 0.0001). We have concluded that the routine performance of a modified radical/radical neck dissection for cN+s should be stopped, as the incidence of Level V positivity is significantly low. Assessing the cN+ for N stage, status of levels III and IV, pattern of invasion, differentiation, and the site may be used instead as predictors for level V positivity.
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Affiliation(s)
- N S S Jayasuriya
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka.
| | - N T Mannapperuma
- Post Graduate Institute of Medicine, 160, Prof Nandadasa Kodagoda Mawatha, Colombo, Sri Lanka.
| | - S Siriwardana
- Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka.
| | - A M Attygalla
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka.
| | - S DeSilva
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka.
| | - H Jinadasa
- Post Graduate Institute of Medicine, 160, Prof Nandadasa Kodagoda Mawatha, Colombo, Sri Lanka.
| | - R Ekanayaka
- Teaching Hospital Karapitiya, Karapitiya, Sri Lanka.
| | - D K Dias
- Teaching Hospital Karapitiya, Karapitiya, Sri Lanka.
| | | | - I Perera
- National Dental Hospital Colombo, Sri Lanka.
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Aboelkheir UM, Iovoli AJ, Platek AJ, Wang C, Hermann GM, Magner WJ, Platek ME, Singh AK, Gupta V, Hicks WL, Arshad H. The Extent of Neck Dissection Among Patients Who Receive Adjuvant Radiotherapy for HNSCC and Its Effect on Disease-Specific and Overall Survival. EAR, NOSE & THROAT JOURNAL 2019; 98:227-231. [PMID: 30943803 DOI: 10.1177/0145561319837142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The study objective was to assess if the extent of neck dissection among patients who receive adjuvant radiotherapy affects regional recurrence and survival. This was a retrospective study of patients who had clinical metastatic mucosal primary squamous cell carcinoma (SCC) to cervical lymph nodes done at Roswell Park Comprehensive Cancer Center, Buffalo, New York from 2004 to 2015. Patients with previous radiotherapy and/or chemotherapy were excluded. All patients had surgery to the primary tumor and the neck followed by adjuvant (chemo) radiation. Patients have been divided into 2 groups according to type of neck dissection as either selective neck dissection (SND) or comprehensive neck dissection (CND). The extent of neck dissection was determined by surgeon preference. All patients received postoperative radiotherapy to the primary tumor bed and to the neck with or without chemotherapy. Main outcomes were measured in regional recurrence and overall survival. In our study, 74 patients were included. Among the 2 groups of patients, 3-year outcomes for regional recurrence occurred in 4 (7.1%) of 56 patients in the SND group and 2 (11.1%) of 18 patients in the CND group. Overall survival was 29 (51.8%) of 56 patients in the SND group and 11 (61.1%) of 18 patients in the CND group ( P = .497). Among patients who died in each cohort, disease-specific death was 20 (74.1%) of 27 patients in the SND group and 5 (71.4%) of 7 patients in the CND group ( P = .79).The overall and disease-specific survival differences between the SND and CND cohorts were not statistically significant. In conclusion, SND, combined with proper adjuvant treatment, achieved regional control and survival rates comparable to CND.
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Affiliation(s)
- Usama M Aboelkheir
- 1 Department of Head and Neck Surgery/Plastic and Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Austin J Iovoli
- 2 Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Alexis J Platek
- 2 Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Chong Wang
- 3 Department of Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Gregory M Hermann
- 2 Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - William J Magner
- 1 Department of Head and Neck Surgery/Plastic and Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Mary E Platek
- 4 Department of Cancer Prevention & Control, Radiation Medicine, Roswell Park Comprehensive Cancer Center and D'Youville College, Buffalo, New York, USA
| | - Anurag K Singh
- 2 Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Vishal Gupta
- 1 Department of Head and Neck Surgery/Plastic and Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Wesley L Hicks
- 1 Department of Head and Neck Surgery/Plastic and Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Hassan Arshad
- 1 Department of Head and Neck Surgery/Plastic and Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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Management of the Neck in Oral Squamous Cell Carcinoma: Background, Classification, and Current Philosophy. Oral Maxillofac Surg Clin North Am 2019; 31:69-84. [PMID: 30449527 DOI: 10.1016/j.coms.2018.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Nodal metastasis is the single most prognostic determinant in patients with oral squamous cell carcinoma (OSCC). Since its inception more than a century ago, the management of the neck has led to decreased surgical morbidity, with continued preservation of oncologic safety for OSCC. Nodal metastasis is the single most prognostic determinant in patients with OSCC. The decision for the extent of the neck dissection is tailored to tumor-specific characteristics, which dictate the probability and extent of nodal metastasis, including tumor size, location, histopathologic characteristics, and the presence or absence of clinical nodal disease. These factors are tools to aid diagnosticians in their decision making for individual patients.
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Abstract
PURPOSE The treatment of a clinically node-positive (cN+) neck is important in the management of oral cavity squamous cell carcinoma (OSCC). However, the extent of neck dissection (ND) remains controversial. The purpose of our study was to evaluate whether level IV or V can be excluded in therapeutic ND for cN+ OSCC patients. MATERIALS AND METHODS We performed a retrospective chart review of 92 patients who underwent a comprehensive or selective ND as a therapeutic treatment of cN+ OSCC from January 1993 to February 2009. RESULTS The incidence rate of metastasis to level IV or V was 22% (16 of 72) on the ipsilateral neck. Of 67 cases without clinically suspicious nodes at level IV or V, 11 cases (16%, 11 of 67) had pathologically proven lymphatic metastasis to level IV or V. Only a nodal staging above N2b was significantly relevant with the higher rate of level IV or V lymph node metastasis (p=0.025). In this series, selective ND, combined with proper adjuvant therapy, achieved regional control and survival rates comparable to comprehensive ND in patients under the N stage of cN2a OSCC. CONCLUSION In conclusion, level IV and V patients can avoid recurrence under cN2a OSCC.
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Affiliation(s)
- Yoo Seob Shin
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Se-Heon Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Chang Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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Azevedo RS, Gouvêa AF, Lopes MA, Corrêa MB, Jorge J. Synchronous oral paracoccidioidomycosis and oral squamous cell carcinomas with submandibular enlargement. Med Mycol 2010; 49:84-9. [PMID: 20608775 DOI: 10.3109/13693786.2010.496118] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Oral paracoccidioidomycosis and oral squamous cell carcinoma may occur in the same patient. As both lesions may present similar clinical and histopathological features, the diagnosis is sometimes challenging. This paper describes the case of a 54-year-old male who was a farm worker and heavy alcohol and tobacco user. He developed paracoccidioidomycosis and two lesions of squamous cell carcinoma in the oral cavity. During the follow-up, the patient presented enlargement of the submandibular lymph nodes, which was thought to be regional metastasis but was diagnosed as paracoccidioidomycosis. Therefore, the significance of this association is emphasized and discussed.
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Affiliation(s)
- Rebeca Souza Azevedo
- Oral Pathology, School of Dentistry, Fluminense Federal University, Nova Friburgo, Rio de Janeiro, Brazil.
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