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Yuan Z, Ren S, Ming H, Zhang X, Zhao Y, Tan X. Neck dissection of cN0 maxillary oral squamous cell carcinoma: A study based on SEER database. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101947. [PMID: 38857692 DOI: 10.1016/j.jormas.2024.101947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 06/08/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE For patients with clinical nodal-negative (cN0) maxillary oral squamous cell carcinoma (MOSCC), neck dissection (ND) and clinical observation are the main two management strategies for the neck. However, the indications corresponding to these two options remain controversial. This study aimed to elucidate the clinical factors affecting ND treatment and to identify clinical characteristics of the population that may benefit from ND based on a retrospective analysis of cN0 MOSCC patient data from the Surveillance, Epidemiology, and End Results (SEER) database. METHODS 8846 MOSCC patients were identified in the SEER database from 2000 to 2020. The Kaplan-Meier method was utilized to examine overall survival (OS) and disease-specific survival (DSS), while the hazard ratio (HR) was estimated using the stepwise multivariate Cox regression model. Furthermore, multi-subgroup analyses of DSS and OS were performed to compare ND and No ND. RESULTS We included 2,512 cN0 MOSCC patients. Basic survival analysis and Cox regression modeling showed that ND was an independent prognostic factor that promoted DSS and OS. Additional subgroup analyses revealed that the primary site and T-stage might influence the efficacy of ND modality. Moreover, patients with T3/T4 stage of upper gingival squamous cell carcinoma (UGSCC) (DSS p = 0.009, OS p = 0.004), hard palate squamous cell carcinoma (HPSCC) (DSS p = 0.001, OS p < 0.001), and soft palate squamous cell carcinoma (SPSCC) (p = 0.029) showed a better survival benefit with ND in OS and DSS. Nonetheless, no differences were observed in OS and DSS between ND and No ND at the T1/T2 stage of the abovementioned primary tumor sites. Additionally, the DSS outcomes for T1/T2 stage upper lip squamous cell carcinoma (ULSCC) patients were significantly worse in the ND group than in the No ND group (p = 0.018). However, no significant differences were noted in OS (p = 0.140) as well as OS (p = 0.248) and DSS (p = 0.627) for T1/T2 and T3/T4 patients, respectively. CONCLUSION Active surveillance might be a feasible strategy for managing all T-staged ULSCC as well as early-stage (T1/T2) UGSCC, SPSCC, and HPSCC, provided regular and meticulous follow-up is performed. Hence, concurrent ND is recommended for patients with intermediate to advanced (T3/T4) stage UGSCC, SPSCC, and HPSCC.
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Affiliation(s)
- Zongyi Yuan
- Department of Oral and maxillofacial surgery, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Shipeng Ren
- Department of Stomatology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Huawei Ming
- Department of Oral and maxillofacial surgery, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Xing'an Zhang
- Department of Oral and maxillofacial surgery, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yang Zhao
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Xiaoyao Tan
- Department of Oral and maxillofacial surgery, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.
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Moratin J, Horn D, Oehme M, Semmelmayer K, Flechtenmacher C, Ristow O, Held T, Engel M, Hoffmann J, Freudlsperger C. Variation of resection margins in oral cancer in dependence of tumor stage and subsite - a retrospective cohort study. Clin Oral Investig 2024; 28:327. [PMID: 38764079 PMCID: PMC11102874 DOI: 10.1007/s00784-024-05711-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/07/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVES Surgical resection is a key component of the treatment of head and neck cancer and the achievement of free surgical margins are essential for the patients' outcome in terms of survival. While there is a general recommendation for a free resection range of 5 mm, up to date, there is a lack of investigations on the quality of tumor resection in dependence of affected subsite and tumor stage. In the presented study, predictors for the achieved resection margins in surgically treated oral squamous cell carcinomas were analyzed. MATERIALS AND METHODS A cohort of 567 patients was included in a retrospective analysis and resection status with exact margin ranges were analysed. Tumor stage, affected subsite and the results of the intraoperative frozen section analysis were assessed. Primary endpoint was the achieved resection margin in mm, secondary endpoints were overall and progression-free survival. RESULTS The observed mean values of minimal resection margins differed significantly between the investigated subsites (p = 0.042),pathological tumor stages (p < 0.001) and in tumors which demonstrated perineural infiltration (Pn1, p = 0.002). Furthermore, there was a significant impact of the results of the intraoperative frozen section analysis on progression-free and overall survival (p < 0.001). CONCLUSIONS Our data clearly indicate that resection status differs between tumors of different subsites and tumor stages. CLINICAL RELEVANCE Clinical procedures should be adapted in order to achieve similar certainty in all resections, and, thus to improve patients' outcome.
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Affiliation(s)
- Julius Moratin
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Dominik Horn
- Department of Oral and Maxillofacial Surgery, Saarland University Hospital, Kirrberger Straße, 66424, Homburg, Germany
| | - Marcel Oehme
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Karl Semmelmayer
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christa Flechtenmacher
- Institute of Pathology, University of Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
| | - Oliver Ristow
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Thomas Held
- Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Michael Engel
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Jürgen Hoffmann
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christian Freudlsperger
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
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Fang Q, Yuan J, Zhang X, Dai L, Luo R, Xu C. Oncologic and functional results between sentinel lymph node biopsy and elective neck dissection in cT1/2N0 maxillary squamous cell carcinoma. Oral Oncol 2024; 152:106810. [PMID: 38631065 DOI: 10.1016/j.oraloncology.2024.106810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/12/2024] [Accepted: 04/13/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE To evaluate the oncologic safety and quality of life associated with the use of sentinel lymph node biopsy (SLNB) as compared to elective neck dissection (END) in patients with cT1/2N0 maxillary squamous cell carcinoma. METHODS This study constituted a retrospective analysis of consecutively treated patients who underwent SLNB or END, with data collected prospectively. We analyzed the impact of the different neck procedures on regional control and disease-specific survival via the Cox model. Patients in both groups completed the University of Washington Quality of Life questionnaire. RESULTS We included a total of 130 patients, with 47 receiving SLNB. In all cases, the sentinel lymph node could be identified, and of these, 5 had a positive result, yielding a sensitivity of 83.3 %, a specificity of 100 %, a false negative rate of 16.7 %, and a negative predictive value of 97.6 %. The sensitivity, specificity, false negative rate, and negative predictive value of END in detecting occult metastasis were 64.3 %, 100 %, 35.7 %, and 93.2 %, respectively. In comparison to END after propensity score matching, SLNB exhibited no significant difference in its effects on regional control (p = 0.519, HR: 1.05, 95 % CI: 0.52-1.93) and disease-specific survival (p = 0.634, HR: 1.22, 95 % CI: 0.53-1.99). Patients in SLNB group showed significantly higher mean scores of shoulder and taste domains at 3 months, 6 months, and 12 months postoperatively compared to those in END group. CONCLUSION SLNB could act as a viable alternative to END in cT1/2N0 maxillary squamous cell carcinoma with comparable prognosis and better quality of life.
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Affiliation(s)
- Qigen Fang
- Department of Head Neck and Thyroid, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou 450008, China.
| | - Junhui Yuan
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou 450008, China
| | - Xu Zhang
- Department of Head Neck and Thyroid, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou 450008, China
| | - Liyuan Dai
- Department of Head Neck and Thyroid, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou 450008, China
| | - Ruihua Luo
- Department of Head Neck and Thyroid, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou 450008, China
| | - Chunmiao Xu
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou 450008, China
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4
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Qayyum MU, Keerio AA, Faisal M, Rashid A, Hussain R, Jamshed A. Survival Outcomes and Patterns of Failure in Maxillary Alveolus Squamous Cell Carcinoma. Int Arch Otorhinolaryngol 2023; 27:e559-e564. [PMID: 37876703 PMCID: PMC10593516 DOI: 10.1055/s-0042-1758214] [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: 02/24/2022] [Accepted: 06/05/2022] [Indexed: 10/26/2023] Open
Abstract
Introduction Squamous cell carcinoma (SCC) of the maxillary alveolus is a relatively rare disease. There is lack of data on this subsite as compared with other sites. The factors that affect survival in cases of maxillary alveolar SCC are tumor stage, local and cervical metastases, histological grading, and the margin status. Objectives To evaluate the overall survival (OS), the disease free survival (DFS), and the complex interaction and effects of margin status, histological differentiation, habits (such as smoking and the use of smokeless tobacco products), and cervical and distant metastases based on clinicopathological data. Methods We examined the electronic database at our hospital from 2003 to 2017. We included all cases with a histopathological diagnosis of SCC of the maxillary alveolus. Tumors originating primarily from the maxillary alveolus were included, while those originating from adjacent subsites, like the hard palate, the buccal mucosa or the maxillary sinus were excluded. We also excluded all the patients who were not operated on with a curative intent. Results More than half of the patients had stage-IV tumors at the time of presentation, while only one fourth of them had nodal metastasis. The rate of recurrence increased in cases of primary tumors in advanced stages and the degree of histological differentiation. The 2-year and 5-year OS rates were of 54.5% (18 patients) and 30.3% (10 patients) respectively. Conclusion Primary tumors in advanced stages, histological grade, and presence of nodal metastasis are poor prognostic markers in terms of long-term survival.
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Affiliation(s)
- Muhammad Umar Qayyum
- Department of Surgical Oncology–Head and Neck Surgery, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
- Department of Maxillofacial Surgery, Combined Military Hospital Lahore, Lahore, Pakistan
| | - Ahmed Ali Keerio
- Department of Surgical Oncology–Head and Neck Surgery, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Muhammad Faisal
- Department of Surgical Oncology–Head and Neck Surgery, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Asma Rashid
- Department of Surgical Oncology–Head and Neck Surgery, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Raza Hussain
- Department of Surgical Oncology–Head and Neck Surgery, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Arif Jamshed
- Department of Clinical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan
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5
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de la Fuente C, Prat-Valero N, Alberola-Ferranti M, Mis-Castell D, Sáez-Barba M, Pujol-Pina R, Pamias-Romero J, Bescós-Atín C. Occult metastases of oral maxillary squamous cell carcinoma: Systematic review and meta-analysis. Head Neck 2023; 45:733-744. [PMID: 36515647 DOI: 10.1002/hed.27276] [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: 03/08/2022] [Revised: 10/30/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Squamous cell carcinoma (SCC) is the most common malignant neoplasm of the oral cavity. The performance of END (elective neck dissection) in cases of maxillary SCC is controversial because the literature traditionally classified maxillary tumors as having low metastatic potential. The aim of this systematic review and meta-analysis was to determine the percentage of occult cervical metastases in maxillary SCC to identify in which cases there is the need to perform an END. We searched the PubMed database to select articles dated from 2000 to 2020 that fulfilled our inclusion criteria; finally, we reviewed 27 manuscripts. We show that the overall cervical and occult metastases rate was 35% and 19%, respectively. For T1, the percentage of occult metastasis rate was 11%; for T2, it was 16%; for T3, it was 20%; and for T4, it was 32%. We suggest END (levels I-II-III) as treatment to T3/T4 cN0 patients.
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Affiliation(s)
- Carlos de la Fuente
- Servei de Cirurgia Oral i Maxil·lofacial, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,CIBBIM-Nanomedicine, Noves Tecnologies i Microcirurgia Craniofacial, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Nil Prat-Valero
- Servei de Cirurgia Oral i Maxil·lofacial, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,CIBBIM-Nanomedicine, Noves Tecnologies i Microcirurgia Craniofacial, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Margarita Alberola-Ferranti
- Servei d'Anatomia Patològica, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - David Mis-Castell
- Servei de Cirurgia Oral i Maxil·lofacial, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,CIBBIM-Nanomedicine, Noves Tecnologies i Microcirurgia Craniofacial, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Manel Sáez-Barba
- Servei de Cirurgia Oral i Maxil·lofacial, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,CIBBIM-Nanomedicine, Noves Tecnologies i Microcirurgia Craniofacial, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Rosa Pujol-Pina
- CIBBIM-Nanomedicine, Noves Tecnologies i Microcirurgia Craniofacial, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Jorge Pamias-Romero
- Servei de Cirurgia Oral i Maxil·lofacial, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,CIBBIM-Nanomedicine, Noves Tecnologies i Microcirurgia Craniofacial, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Coro Bescós-Atín
- Servei de Cirurgia Oral i Maxil·lofacial, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,CIBBIM-Nanomedicine, Noves Tecnologies i Microcirurgia Craniofacial, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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6
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Ohyama Y, Yamashiro M, Michi Y, Uzawa N, Myo K, Sonoda I, Sumino J, Miura C, Mizutani M, Yamamoto D, Kayamori K, Yoda T. Determination of Significant Prognostic Factors for Maxillary Gingival Squamous Cell Carcinoma in 90 Cases. Indian J Otolaryngol Head Neck Surg 2022; 74:5930-5935. [PMID: 36742798 PMCID: PMC9895216 DOI: 10.1007/s12070-021-02559-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: 12/24/2020] [Accepted: 04/12/2021] [Indexed: 02/07/2023] Open
Abstract
Maxillary gingival squamous cell carcinoma (MGSCC) occurs rather infrequently, compared to tongue and mandibular gingival carcinomas, among the cancers of the oral cavity. Therefore, significant numbers of MGSCC cases have not been statistically analysed. The aim of this study is to clarify the prognostic factors for MGSCC. We performed the statistical analysis of 90 MGSCC cases primarily treated in our department from 1999 to 2014. The patients (male: 36, female: 54) were aged between 38 and 93 years, and the mean age was 68.7 years. The number of patients in each tumour stage according to the TNM classification was as follows: T1: 15 cases, T2: 32 cases, T3: 13 cases, and T4: 30 cases. Forty-two patients were treated only by surgery, 5 only by radiotherapy, 3 by preoperative radiotherapy and surgery, and 40 patients were treated by combination therapy with preoperative chemoradiotherapy and surgery. Neck dissections were performed in 40 cases including 29 cases (11 primary and 18 secondary cases) of histopathologically diagnosed lymph node metastases. Extranodal extension was found in 74.3% cases with metastatic lymph nodes. The 5-year overall survival rate was 81.9%. In univariate analysis, the site of occurrence, stage of tumour, lymph node metastasis, and treatment contributed to the 5-year survival rate. Multivariate analysis demonstrated that the site of occurrence (posterior region) was an independent prognostic factor. Seventeen deaths occurred due to the primary disease, while three deaths were caused by other diseases. The posterior region cancers, according to the classification based on site of occurrence, were independent predictors of poor 5-year overall survival rate.
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Affiliation(s)
- Yoshio Ohyama
- Department of Oral and Maxillofacial Surgery, Shizuoka City Shizuoka Hospital, 10-93, Outemachi, Aoi-ku, Shizuoka-shi, Shizuoka 420-8690 Japan
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45Bunkyo-ku, Yushima, Tokyo 113-8510 Japan
| | - Masashi Yamashiro
- Department of Dentistry and Oral Surgery, NTT Medical Center, 5-9-22 Higashigotannda, Shinagawa-ku, Tokyo 141-8625 Japan
| | - Yasuyuki Michi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45Bunkyo-ku, Yushima, Tokyo 113-8510 Japan
| | - Narikazu Uzawa
- Department of Oral and Maxillofacial Surgery II, Osaka University, 1-8 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Kunihiro Myo
- Department of Head and Neck Surgery, Gunma Prefectural Cancer Center, 617-1 Takahayashinishi-cho, Oota-shi, Gunma 373-0828 Japan
| | - Itaru Sonoda
- Department of Dentistry and Oral Surgery, Moriyama Memorial, 4-3-1 Kitakasai, Edogawa-ku, Tokyo 134-0081 Japan
| | - Jun Sumino
- Department of Oral Surgery, Saitama Cancer Center, 780, Komuro, Inamachi, Kitaadachigun, Saitama 362-0806 Japan
| | - Chika Miura
- Department of Oral Surgery, Japanese Red Cross Aahikaga Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi 326-0843 Japan
| | - Miho Mizutani
- Department of Dentistry and Oral Surgery, NTT Medical Center, 5-9-22 Higashigotannda, Shinagawa-ku, Tokyo 141-8625 Japan
| | - Daisuke Yamamoto
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45Bunkyo-ku, Yushima, Tokyo 113-8510 Japan
| | - Kou Kayamori
- Department of Oral Pathology, Tokyo Medical and Dental University, 1-5-45Bunkyo-ku, Yushima, Tokyo 113-8510 Japan
| | - Tetsuya Yoda
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45Bunkyo-ku, Yushima, Tokyo 113-8510 Japan
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7
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Doll C, Mrosk F, Wuester J, Runge AS, Neumann F, Rubarth K, Heiland M, Kreutzer K, Voss J, Raguse JD, Koerdt S. Pattern of cervical lymph node metastases in squamous cell carcinoma of the upper oral cavity – How to manage the neck. Oral Oncol 2022; 130:105898. [DOI: 10.1016/j.oraloncology.2022.105898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 11/29/2022]
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Thoenissen P, Heselich A, Deeg S, Al-Maawi S, Tanneberger A, Sader R, Ghanaati S. Extent of Neck Dissection and Cervical Lymph Node Involvement in Oral Squamous Cell Carcinoma. Front Oncol 2022; 12:812864. [PMID: 35686113 PMCID: PMC9172998 DOI: 10.3389/fonc.2022.812864] [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: 11/10/2021] [Accepted: 04/15/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Tumor resection combined with neck dissection (ND) or radiotherapy are established methods for the treatment of patients with oral squamous cell carcinoma (OSCC). However, the extent of ND can lead to postoperative complications. Therefore, for the first time, this study aims to identify lymph node involvement in OSCC performed in a bilateral systematic approach based on oncologic board meetings relying on presurgical magnetic resonance imaging (MRI) and computed tomography (CT). Materials and Methods In a retrospective single-center study, patients with primary OSCC resection and systematic ND performed in 4 different manners (MRND III bilateral, MRND III left and SND right, MRND III right, SND left, and SND bilateral) were examined. Lymph node involvement allocated to levels was evaluated depending on primary localization and T-stage. Results A total of 177 consecutive patients (mean age 63.64; 92 female, male 85) were enrolled in this study. A total of 38.98% showed cervical lymph node involvement, and metastases were found in levels 1–4. The distribution of positive lymph node metastases (n=190 LNs) was 39.47% in level 1, 38.95% in level 2, 10.53% in level 3, and 11.05% in level 4. Discussion In a cohort of OSCC patients with systematic bilateral ND, levels 1 and 2 had positive lymph node involvement, and no lymph node involvement was seen at level 5. Without any clinical or imaging suspicion, ND expanding 5-level MRND should be avoided regardless of the primary tumor localization, T-stage and intraoperative proof of cervical metastases.
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Affiliation(s)
- Philipp Thoenissen
- Clinic for Maxillofacial and Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt Am Main, Germany
| | - Anja Heselich
- Clinic for Maxillofacial and Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt Am Main, Germany.,Frankfurt Oral Regenerative Medicine (FORM), Clinic for Maxillofacial and Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt Am Main, Germany
| | - Stefanie Deeg
- Clinic for Maxillofacial and Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt Am Main, Germany.,Frankfurt Oral Regenerative Medicine (FORM), Clinic for Maxillofacial and Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt Am Main, Germany
| | - Sarah Al-Maawi
- Clinic for Maxillofacial and Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt Am Main, Germany.,Frankfurt Oral Regenerative Medicine (FORM), Clinic for Maxillofacial and Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt Am Main, Germany
| | - Anna Tanneberger
- Clinic for Maxillofacial and Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt Am Main, Germany
| | - Robert Sader
- Clinic for Maxillofacial and Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt Am Main, Germany
| | - Shahram Ghanaati
- Clinic for Maxillofacial and Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt Am Main, Germany.,Frankfurt Oral Regenerative Medicine (FORM), Clinic for Maxillofacial and Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt Am Main, Germany
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9
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Slieker FJB, Rombout DAA, de Bree R, Van Cann EM. Local recurrence and survival after treatment of oral squamous cell carcinoma of the maxilla: A systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 133:626-638. [PMID: 35165055 DOI: 10.1016/j.oooo.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/15/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Oral squamous cell carcinoma involving the maxilla (MSCC) is a rare malignancy. The aim was to perform a systematic review and meta-analysis of available literature on local recurrence (LR), overall survival (OS), and associated risk factors of MSCC. STUDY DESIGN The Cochrane, PubMed, and EMBASE databases were searched with related keywords and synonyms. The pooled proportions of both LR and OS were subsequently calculated with 95% confidence intervals. RESULTS In total, 2638 articles were screened on title and abstract, 131 articles were screened on full text, and 20 were included. The pooled 5-year LR rate was 19.3%, and the 5-year OS rate was 53.7%. The subgroup analysis between surgery only and surgery with (neo)adjuvant treatment resulted in an odds ratio (OR) of .76 (95% confidence interval [CI]; .41-1.40). CONCLUSIONS Postoperative (chemo)radiotherapy or preoperative intra-arterial chemoradiotherapy improves survival when adverse tumor characteristics are present. Posterior tumor extension into the soft palate, pterygoid muscle, pterygoid process, and infratemporal fossa was significantly associated with decreased OS in multiple studies. More research into the risk-reduction of local recurrence is warranted.
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Affiliation(s)
- F J B Slieker
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - D A A Rombout
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - R de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - E M Van Cann
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
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Kovalski LNS, Zanella VG, Jardim LC, Só BB, Girardi FM, Kroef RG, Barra MB, Carrard VC, Martins MD, Martins MAT. Prognostic factors from squamous cell carcinoma of the hard palate, gingiva and upper alveolar ridge. Braz Oral Res 2022; 36:e058. [PMID: 36507745 DOI: 10.1590/1807-3107bor-2022.vol36.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/12/2022] [Indexed: 12/24/2022] Open
Abstract
The purpose of this study was to evaluate the clinicodemographic characteristics and treatment protocol as prognostic factors in patients with oral squamous cell carcinoma (OSCC) of the hard palate, upper gingiva, and alveolar ridge (HPUGAR). This retrospective cohort study collected data of patients treated in two head and neck surgery departments in southern Brazil between 1999 and 2021. Information on clinicodemographic data, habits, site, size, clinical aspect, clinical staging, cervical metastasis, treatment, and survival was collected. Associations between independent variables and outcomes were assessed using Pearson's chi-square test and binary regression. Kaplan-Meier test was employed to compare the survival between the neck approaches. Forty-one patients were included; most were male (61%), with a mean age of 68.8 (± 13.9) years. The consumption of tobacco (p = 0.003) and alcohol (p = 0.02) was significantly higher in male than in female patients. The main clinical features observed in the study sample were lesions larger than 2 cm (48.7%), no cervical (90.2%), or distant metastasis (90.2%). Surgery alone was the main treatment approach (48.8%). The watch-and-wait strategy was adopted in 34 cases (83.0%), while elective neck dissection was applied in five (12.2%). Only two patients with cN0 disease (4.9%) presented with cervical metastasis at follow-up. Eight patients (12.2%) died of the disease. Clinicodemographic variables, habits, surgical margins, and histological subtype were not significantly associated with cervical metastasis or survival. Cervical metastasis (p = 0.004) was associated with poor survival. No difference was detected in survival between different neck approaches (p = 0.28). Cervical metastasis and local recurrence are negative prognostic factors for HPUGAR OSCC.
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Affiliation(s)
- Luan Nathiel Santana Kovalski
- Universidade Federal do Rio Grande do Sul - UFRGS, Department of Oral Pathology and Oral Medicine, Porto Alegre, RS, Brazil
| | - Virgilio Gonzalez Zanella
- Complexo Hospitalar Santa Casa, Hospital Santa Rita, Department of Head and Neck Surgery, Porto Alegre, RS, Brazil
| | - Luisa Comerlato Jardim
- Universidade Federal do Rio Grande do Sul - UFRGS, Department of Oral Pathology and Oral Medicine, Porto Alegre, RS, Brazil
| | - Bruna Barcelos Só
- Universidade Federal do Rio Grande do Sul - UFRGS, Department of Oral Pathology and Oral Medicine, Porto Alegre, RS, Brazil
| | - Fabio Muradás Girardi
- Hospital Ana Nery, Department of Head and Neck Surgery, Santa Cruz do Sul, RS, Brazil
| | - Ricardo Gallicchio Kroef
- Complexo Hospitalar Santa Casa, Hospital Santa Rita, Department of Head and Neck Surgery, Porto Alegre, RS, Brazil
| | - Marinez Bizarro Barra
- Complexo Hospitalar Santa Casa, Hospital Santa Rita, Deparment of Pathology, Porto Alegre, RS, Brazil
| | - Vinicius Coelho Carrard
- Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clínicas de Porto Alegre, Department of Oral Medicine, Porto Alegre, RS, Brazil
| | - Manoela Domingues Martins
- Universidade Federal do Rio Grande do Sul - UFRGS, Department of Oral Pathology and Oral Medicine, Porto Alegre, RS, Brazil
| | - Marco Antonio Trevizani Martins
- Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clínicas de Porto Alegre, Department of Oral Medicine, Porto Alegre, RS, Brazil
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Fatty Acid Receptor CD36 Functions as a Surrogate Parameter for Lymph Node Metastasis in Oral Squamous Cell Carcinoma. Cancers (Basel) 2021; 13:cancers13164125. [PMID: 34439279 PMCID: PMC8391200 DOI: 10.3390/cancers13164125] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 12/16/2022] Open
Abstract
Simple Summary The frequent occurrence of occult cervical lymph node metastasis is still a therapeutic challenge in oral squamous cell carcinoma (OSCC) and represents a limiting factor in terms of survival. The common staging of malignancy is not precise enough to predict the development of lymph node metastases and additional prognostic factors are needed. In this study we show that CD36, a protein related to fatty acid metabolism, is expressed in OSCC and correlates with the occurrence of lymph node metastasis. CD36 may be useful as a specific parameter for lymph node metastasis and as a progression parameter for survival. Therefore, CD36 could be useful for risk stratification regarding lymph node metastasis in OSCC and, beyond that, CD36 could also be a possible therapeutic target in future. Abstract Purpose: To investigate the expression pattern of CD36 in a patient population with oral squamous cell carcinoma (OSCC) and to correlate CD36 expression with clinical and histopathological parameters. The hypothesis was that CD36 expression correlates with the occurrence of lymph node metastasis. Methods: To address the study objectives, a retrospective cohort study was conducted. Study variables included demographic, histopathological and survival data. CD36 expression patterns were assessed by immunohistochemistry on tissue microarrays (TMA). Logistic regression analysis, survival analysis and Cox proportional hazards model were performed. Results: High CD36 expression correlated significantly with a higher T-status, grading and occurrence of lymph node metastasis. The logistic regression with binary N status as a dependent variable showed that high CD36 expression increased the chance for lymph node metastasis 45-fold (OR = 44.7, 95% CI: 10.0–316). Patients with high CD36 expression had lower probabilities of progression-free survival. CD36 had a small and non-significant independent influence on progression-free survival. Conclusions: CD36 is expressed in OSCC and correlates with tumor grading, T-status, and especially the occurrence of lymph node metastasis. CD36 may be useful for risk stratification regarding lymph node metastasis in OSCC.
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Metzger K, Moratin J, Horn D, Pilz M, Ristow O, Hoffmann J, Freier K, Engel M, Freudlsperger C. Treatment delay in early-stage oral squamous cell carcinoma and its relation to survival. J Craniomaxillofac Surg 2021; 49:462-467. [PMID: 33648813 DOI: 10.1016/j.jcms.2021.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 01/02/2021] [Accepted: 02/07/2021] [Indexed: 12/24/2022] Open
Abstract
The aim of this study was to investigate the impact of a prolonged treatment delay on survival in patients with primary oral squamous cell carcinoma. The investigators hypothesized that treatment delay affects survival, supposing a poor outcome in patients with prolonged treatment initiation. In addition, a critical treatment delay should be defined. Inclusion criteria were a histopathological diagnosis of primary squamous cell carcinoma of the oral cavity and a surgery-based treatment of the tumor. Patients with a history of previously diagnosed malignancies and patients with distant metastasis at the time of diagnosis were excluded from this protocol. Common clinical and histopathological data were assessed retrospectively. Treatment delay was analyzed for the interval between initial presentation and the date of surgery. A total of 484 patients could be included. Considering early-stage patients, the risk of death increases by 1.8% for each day that the treatment delay is prolonged if all other characteristics do not change (p = 0.0035). In patients with advanced disease, a prolonged treatment delay does not affect the risk of death (p = 0.9134). In terms of progression-free survival, treatment delay tends to be associated with a higher risk of recurrence in early-stage disease, but without being statistically significant (p = 0.0718). For patients with early-stage disease, a treatment delay of 20 days is critical regarding overall survival (p = 0.011). For patients with advanced-stage disease, no significant differences have been observed. As patients with early-stage oral squamous cell carcinoma profit from early treatment initiation, we suggest an acceptable maximum treatment delay of no more than 20 days in the surgical management of these patients.
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Affiliation(s)
- Karl Metzger
- Heidelberg University Hospital, Department of Oral and Cranio-Maxillofacial Surgery, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany.
| | - Julius Moratin
- Heidelberg University Hospital, Department of Oral and Cranio-Maxillofacial Surgery, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Dominik Horn
- Saarland University Hospital, Department of Oral and Cranio-Maxillofacial Surgery, Kirrberger Str. 100, D-66421, Homburg, Germany
| | - Maximilian Pilz
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, D-69120, Heidelberg, Germany
| | - Oliver Ristow
- Heidelberg University Hospital, Department of Oral and Cranio-Maxillofacial Surgery, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Jürgen Hoffmann
- Heidelberg University Hospital, Department of Oral and Cranio-Maxillofacial Surgery, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Kolja Freier
- Saarland University Hospital, Department of Oral and Cranio-Maxillofacial Surgery, Kirrberger Str. 100, D-66421, Homburg, Germany
| | - Michael Engel
- Heidelberg University Hospital, Department of Oral and Cranio-Maxillofacial Surgery, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Christian Freudlsperger
- Heidelberg University Hospital, Department of Oral and Cranio-Maxillofacial Surgery, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
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Moratin J, Horn D, Metzger K, Ristow O, Flechtenmacher C, Engel M, Hoffmann J, Freier K, Freudlsperger C. Squamous cell carcinoma of the mandible - Patterns of metastasis and disease recurrence in dependence of localization and therapy. J Craniomaxillofac Surg 2020; 48:1158-1163. [PMID: 33199211 DOI: 10.1016/j.jcms.2020.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/20/2020] [Accepted: 10/25/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Oral squamous cell carcinomas exhibit distinct patterns of disease progression, depending on their localisation. This study aimed to evaluate clinicopathological data in patients with tumors of the mandibular alveolar process, to facilitate risk assessment and therapy planning. MATERIALS AND METHODS A retrospective cohort study was designed including patients with squamous cell carcinoma of the mandibular gingiva. Clinical and pathological data were collected to determine the rate of cervical metastases and clinical outcomes depending on tumor stage, localization (anterior, intermediate and posterior) and the extent of tumor resection. RESULTS 120 patients were included in the analysis. Rate of metastases was 42.6%. Tumors of the anterior part of the mandible exhibited significantly higher rates of bilateral metastases (anterior: 85.7%, intermediate: 15.8%, posterior: 4%, p < 0.001) and local recurrence (anterior: 25%, intermediate: 16.3%, posterior: 5.5%, p = 0.03) compared to posterior malignancies. CONCLUSION Tumors of the anterior segment of the mandible are characterized by high rates of metastases and local recurrence. Therefore, we propose radical segmental resection and bilateral neck dissection in those patients.
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Affiliation(s)
- Julius Moratin
- University of Heidelberg, Department of Oral and Cranio-Maxillofacial Surgery (Head of Department: Prof. Dr. Dr. J. Hoffmann), Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany.
| | - Dominik Horn
- Saarland University Hospital, Department of Oral and Cranio-Maxillofacial Surgery (Head of Department: Prof. Dr. Dr. K. Freier), Kirrberger Straße, D-66424 Homburg, Germany
| | - Karl Metzger
- University of Heidelberg, Department of Oral and Cranio-Maxillofacial Surgery (Head of Department: Prof. Dr. Dr. J. Hoffmann), Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
| | - Oliver Ristow
- University of Heidelberg, Department of Oral and Cranio-Maxillofacial Surgery (Head of Department: Prof. Dr. Dr. J. Hoffmann), Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
| | - Christa Flechtenmacher
- University of Heidelberg, Institute of Pathology (Head of Department: Prof. Dr. P. Schirmacher), Im Neuenheimer Feld 224, D-69120 Heidelberg, Germany
| | - Michael Engel
- University of Heidelberg, Department of Oral and Cranio-Maxillofacial Surgery (Head of Department: Prof. Dr. Dr. J. Hoffmann), Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
| | - Jürgen Hoffmann
- University of Heidelberg, Department of Oral and Cranio-Maxillofacial Surgery (Head of Department: Prof. Dr. Dr. J. Hoffmann), Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
| | - Kolja Freier
- Saarland University Hospital, Department of Oral and Cranio-Maxillofacial Surgery (Head of Department: Prof. Dr. Dr. K. Freier), Kirrberger Straße, D-66424 Homburg, Germany
| | - Christian Freudlsperger
- University of Heidelberg, Department of Oral and Cranio-Maxillofacial Surgery (Head of Department: Prof. Dr. Dr. J. Hoffmann), Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
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MacDonald D, Martin M, Nguyen C. Malignant lesions in the anterior maxilla. Clin Radiol 2020; 75:497-506. [DOI: 10.1016/j.crad.2019.09.133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 09/23/2019] [Indexed: 12/16/2022]
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Clinical course and survival in patients with squamous cell carcinoma of the maxillary alveolus and hard palate: Results from a single-center prospective cohort. J Craniomaxillofac Surg 2019; 48:111-116. [PMID: 31884030 DOI: 10.1016/j.jcms.2019.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/15/2019] [Accepted: 12/05/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Operative management of squamous cell carcinoma of the maxillary alveolus and hard palate (MHSCC) is still a controversial issue, especially for cN0 cases. We report the survival outcomes in patients with MHSCC, including the rate of cervical occult metastasis for UICC stages I/II and survival after elective neck dissection (END). METHODS 77 patients with primary MHSCC were followed-up from 2 months to 14.6 years within a prospectively obtained patient cohort. Factors influencing overall survival (OS), oral cancer-specific survival (OCSS) and disease-free survival (DFS) were assessed. We estimated survival probabilities using Kaplan-Meier survival analysis by histology and stage. We used Cox's proportional hazard regression model to estimate adjusted hazard ratios for OS, OCSS and DFS. RESULTS Initially, 22 patients presented with stage I, 13 with stage 2, 11 patients with stage 3 and 31 with stage 4 tumors. The presence of nodal disease rose with increased tumor size. 66.2% were treated with surgery only, 26.0% received adjuvant radiotherapy, and 7.8% received primary radiotherapy. Median overall survival was 10.9 years, and survival probabilities at 2, 5 and 10 years were 68.2%, 61.1% and 61.1%, respectively. Five-year overall survival was 72.4% in the END group and 88.9% in the non-END group. Factors influencing OS, OCSS and DFS were tumor size, the presence of metastatic disease and positive resection margins. CONCLUSIONS MHSCC seems to show a better overall survival compared to OSCC of other locations and is less likely to develop regional and distant metastasis; END might not be necessary in early stage tumors.
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Moratin J, Metzger K, Kansy K, Ristow O, Engel M, Hoffmann J, Flechtenmacher C, Freier K, Freudlsperger C, Horn D. The prognostic significance of the lymph node ratio in oral cancer differs for anatomical subsites. Int J Oral Maxillofac Surg 2019; 49:558-563. [PMID: 31740138 DOI: 10.1016/j.ijom.2019.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/10/2019] [Accepted: 10/21/2019] [Indexed: 11/15/2022]
Abstract
The aim of this study was to validate the prognostic significance of the lymph node ratio (LNR) in patients suffering from oral squamous cell carcinoma in regard to different anatomical subsites. A cohort of 430 patients was investigated to determine the rates of primary metastasis and local and regional disease recurrence. Correlation analysis of the LNR with relevant clinical and pathological parameters was performed. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the prognostic impact for different subsites. Significantly differing rates of primary metastasis and loco-regional disease recurrence were found for cancer of different anatomical subsites of the head and neck. Furthermore, ROC curve analysis suggested that LNR has prognostic relevance in subsets of cancer (tongue, P< 0.001; alveolar process, P= 0.04; maxilla, P= 0.03; buccal mucosa, P= 0.02). The LNR of cancer located in the soft palate (P= 0.6) and floor of the mouth (P= 0.11) showed little or no association with the clinical outcome. There is the need for a more sensitive consideration of the LNR as a factor in the assessment of risk and the treatment decision, as the anatomical subsite plays a crucial role in its impact on the clinical outcome.
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Affiliation(s)
- J Moratin
- Department of Oral and Craniomaxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany.
| | - Karl Metzger
- Department of Oral and Craniomaxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - K Kansy
- Department of Oral and Craniomaxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - O Ristow
- Department of Oral and Craniomaxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - M Engel
- Department of Oral and Craniomaxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - J Hoffmann
- Department of Oral and Craniomaxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - C Flechtenmacher
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - K Freier
- Department of Oral and Craniomaxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany; Department of Oral and Craniomaxillofacial Surgery, Saarland University Hospital, Homburg, Germany
| | - C Freudlsperger
- Department of Oral and Craniomaxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - D Horn
- Department of Oral and Craniomaxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany; Department of Oral and Craniomaxillofacial Surgery, Saarland University Hospital, Homburg, Germany
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Moratin J, Metzger K, Engel M, Hoffmann J, Freudlsperger C, Freier K, Horn D. The occurrence of cervical metastases in squamous cell carcinoma of the tongue: Is there a rationale for bilateral neck dissection in early-stage tumors? J Craniomaxillofac Surg 2019; 47:1134-1138. [DOI: 10.1016/j.jcms.2019.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/05/2019] [Accepted: 03/04/2019] [Indexed: 10/27/2022] Open
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