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Yamazaki M, Sekikawa S, Suzuki T, Ogane S, Hashimoto K, Sasaki A, Nomura T. Rac1 activation in oral squamous cell carcinoma as a predictive factor associated with lymph node metastasis. Int J Clin Oncol 2023; 28:1129-1138. [PMID: 37418142 DOI: 10.1007/s10147-023-02374-2] [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: 04/19/2023] [Accepted: 06/19/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVES Secondary lymph node metastasis (SLNM) indicates a poor prognosis, and limiting it can improve the survival rate in early-stage tongue squamous cell carcinoma (TSCC). Many factors have been identified as predictors of SLNM; however, there is no unified view. Ras-related C3 botulinum toxin substrate 1 (Rac1) was found to be a promoter of the epithelial-mesenchymal transition (EMT) and is also attracting attention as a new therapeutic target. This study aims to investigate the role of Rac1 in metastasis and its relationship with pathological findings in early-stage TSCC. MATERIALS AND METHODS Rac1 expression levels of 69 cases of stage I/II TSCC specimens and their association with clinicopathological characteristics were evaluated by immunohistochemical staining. The role of Rac1 in oral squamous cell carcinoma (OSCC) was examined after Rac1 in OSCC cell lines was silenced in vitro. RESULTS High Rac1 expression was significantly associated with the depth of invasion (DOI), tumor budding (TB), vascular invasion, and SLNM (p < 0.05). Univariate analyses revealed that Rac1 expression, DOI, and TB were factors significantly associated with SLNM (p < 0.05). Moreover, our multivariate analysis suggested that Rac1 expression was the only independent determinant of SLNM. An in vitro study revealed that Rac1 downregulation tended to decrease cell migration and proliferation. CONCLUSION Rac1 was suggested to be an important factor in the metastasis of OSCC, and it could be useful as a predictor of SLNM.
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Affiliation(s)
- Masae Yamazaki
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, Chiyoda, Japan.
| | | | - Taiki Suzuki
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, Chiyoda, Japan
- Oral Cancer Center, Tokyo Dental College, Chiyoda, Japan
| | - Satoru Ogane
- Department of Plastic, Oral and Maxillofacial Surgery, Teikyo University School of Medicine, Itabashi, Japan
| | - Kazuhiko Hashimoto
- Department of Pathology and Laboratory Medicine, Ichikawa General Hospital, Tokyo Dental College, Chiyoda, Japan
| | - Aya Sasaki
- Department of Pathology and Laboratory Medicine, Ichikawa General Hospital, Tokyo Dental College, Chiyoda, Japan
| | - Takeshi Nomura
- Department of Oral Oncology, Oral and Maxillofacial Surgery, Tokyo Dental College, Chiyoda, Japan
- Oral Cancer Center, Tokyo Dental College, Chiyoda, Japan
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Akamatsu M, Makino T, Morita S, Noda Y, Kariya S, Onoda T, Ando M, Kimata Y, Nishizaki K, Okano M, Oka A, Kanai K, Watanabe Y, Imanishi Y. Midline involvement and perineural invasion predict contralateral neck metastasis that affects overall and disease-free survival in locally advanced oral tongue squamous cell carcinoma. Front Oncol 2022; 12:1010252. [DOI: 10.3389/fonc.2022.1010252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionAlthough patients with oral squamous cell carcinoma who develop contralateral neck metastasis (CLNM) have worse survival outcomes than those without CLNM, accurate prediction of occult CLNM in clinically negative contralateral neck (contralateral cN0) remains difficult. This study aimed to identify clinicopathological factors that could reliably predict CLNM in patients with locally advanced (clinical T3 and T4a) tongue squamous cell carcinoma (TSCC).Patients and methodsThe medical data of 32 patients with cT3–4a TSCC who underwent curative surgery between 2010 and 2017 were retrospectively analyzed. The correlation of clinicopathological variables with CLNM was examined using logistic regression analysis. The diagnostic performance of significant variables was evaluated using the area under the receiver operating characteristic curves (AUC). Overall survival (OS) and disease-free survival (DFS) were assessed using a Cox proportional hazards model.ResultsCLNM was eventually confirmed in 11 patients (34.4%). Multivariate logistic regression showed that midline involvement [odds ratio (OR) = 23.10, P = 0.017] and perineural invasion (PNI, OR = 14.96, P = 0.014) were independent predictors of CLNM. Notably, the prediction model comprising a combination of midline involvement and PNI exhibited superior diagnostic performance with an even higher OR of 80.00 (P < 0.001), accuracy of 90.3%, and AUC of 0.876. The multivariate Cox hazards model revealed independent significance of CLNM as an unfavorable prognostic factor for both OS [hazard ratio (HR) = 5.154, P = 0.031] and DFS (HR = 3.359, P = 0.038), as well as that of PNI for OS (HR = 5.623, P = 0.033).ConclusionOur findings suggest that coexisting midline involvement and PNI of the primary tumor is highly predictive of CLNM development, which independently affects both OS and DFS in patients with locally advanced TSCC. Such reliable prediction enables efficient control of CLNM by optimizing management of the contralateral cN0 neck, which will likely contribute to improved prognosis of those patients without unnecessarily compromising their quality of life.
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Evaluation of Expression Of ADAM 10 as a Predictor of Lymph Node Metastasis in Oral Squamous Cell Carcinoma-An Immunohistochemical Study. Head Neck Pathol 2022; 16:1055-1062. [PMID: 35771404 PMCID: PMC9729510 DOI: 10.1007/s12105-022-01466-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lymph node metastasis (LNM) is a well-known prognostic factor in Oral Squamous Cell Carcinoma(OSCC). A biological marker that predicts the Lymph Node Metastasis (LNM) in OSCC cases is the need of the hour. A Disintegrin And Metalloproteinases (ADAMs), a family of proteins that exhibit a metalloproteinase domain play a pivotal role in the pathogenesis of tumor growth and metastasis. This study aims to evaluate whether ADAM 10 can be used as a predictor of lymph node metastasis in OSCC using immunohistochemistry. METHOD A total of 90 samples that were categorized into 3 groups were included in the present study. Group I consisted of 30 samples of the normal oral mucosa, and Group II consisted of 30 samples of OSCC without lymph node metastasis. Group III consisted of 30 samples of OSCC with lymph node metastasis. Esophageal Squamous Cell Carcinoma was used as external positive control. Immunohistochemical expression of ADAM10 in their corresponding stained sections was assessed and staining intensity was calculated. RESULTS ADAM10 immunoreactivity was considered positive when located in cytoplasm or membrane or both. This method is similar to that used by Bamane et al. for OSCC cases. The mean value of the Staining Index score "AxB" was highest in Group III (7.90), followed by Group II (3.13) and least in Group I (0.27). These values were statistically significant. CONCLUSION Considering the findings of a higher percentage of ADAM10 positive cells, higher staining intensity, and higher staining index, the overexpression of ADAM10 can be used as an independent marker for OSCC patients to predict the lymph node metastasis.
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Lalfamkima F, Georgeno GL, Rao NK, Selvakumar R, Devadoss VJ, Rajaram N, Farid S, Lalchhuanawma T, Nayyar AS. Clinical diagnostic criteria versus advanced imaging in prediction of cervical lymph node metastasis in oral squamous cell carcinomas: A magnetic resonance imaging based study. J Carcinog 2021; 20:3. [PMID: 34211339 PMCID: PMC8202445 DOI: 10.4103/jcar.jcar_27_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/02/2021] [Accepted: 02/19/2021] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND AIM: The inaccuracies in clinical examination have been well documented, while advanced imaging modalities, including computed tomography and magnetic resonance imaging (MRI), have been shown to have superior diagnostic accuracy in detecting occult and nodal metastasis. The aim of the present study was to identify as well as evaluate the inaccuracies in clinical examination and of clinical diagnostic criteria in known cases of oral squamous cell carcinomas (OSCCs) with the help of MRI. MATERIALS AND METHODS: A total of 24 patients attending as outpatients were included in the study, while clinically diagnosed and histopathologically proven cases of OSCC were examined clinically and then subjected to advanced imaging with the help of MRI. STATISTICAL ANALYSIS USED: Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 17.0 (SPSS Inc., Chicago, IL, USA), while paired t-test was performed for evaluating the size of tumor and lymph node recorded on clinical and imaging findings. A P < 0.05 was considered statistically significant. RESULTS: Detection of tumor size and lymph node metastasis was found to be higher in case of MRI than when accomplished by clinical staging alone, while paired t-test values for difference in results were found to be statistically significant (P < 0.05). CONCLUSIONS: The present study showed that clinical diagnostic criteria alone were not sufficient and reliable for detecting metastatic lymphadenopathy, highlighting the significance of advanced imaging modalities such as MRI for an efficient preoperative diagnostic workup, as well a tool for planning treatment in patients with OSCCs.
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Affiliation(s)
- F Lalfamkima
- Consultant Dental Surgeon, Selection Grade, Dental Department, Civil Hospital, Aizawl, Mizoram, India
| | - G L Georgeno
- Consultant Dental Surgeon, Selection Grade, Dental Department, Civil Hospital, Aizawl, Mizoram, India
| | - N Koteswara Rao
- Department of Oral and Maxillofacial Surgery, Rajas Dental College and Hospital, Kavalkinaru, Tirunelveli, India
| | - Rajkumar Selvakumar
- Department of Oral and Maxillofacial Surgery, Drs Sudha and Nageswara Rao Siddhartha Institute of Dental Sciences, Chinoutpalli, Gannavaram Mandal, Krishna District, Andhra Pradesh, India
| | - Vimal Joseph Devadoss
- Consultant Dental Surgeon, Selection Grade, Dental Department, Civil Hospital, Aizawl, Mizoram, India
| | - Niroshini Rajaram
- Department of Oral and Maxillofacial Surgery, Rajah Muthiah Dental College and Hospital, Annamalai University, Annamalai Nagar, Cuddalore, India
| | - Shomaila Farid
- Department of Oral Pathology and Microbiology, RVS Dental College and Hospital, Sulur, Coimbatore, Tamil Nadu, India
| | - T Lalchhuanawma
- Consultant Dental Surgeon, Selection Grade, Dental Department, Civil Hospital, Aizawl, Mizoram, India
| | - Abhishek Singh Nayyar
- Consultant, Division of Infection Prevention and Control, Infection Control Department, Security Forces Specialized Health Center, Taif, Kingdom of Saudi Arabia, India
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Intraoral Ultrasonographic Features of Tongue Cancer and the Incidence of Cervical Lymph Node Metastasis. J Oral Maxillofac Surg 2021; 79:932-939. [DOI: 10.1016/j.joms.2020.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023]
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Choi KY, Park SC, Kim JH, Lee DJ. The occult nodal metastasis rate of early tongue cancer (T1-T2): A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24327. [PMID: 33546063 PMCID: PMC7837872 DOI: 10.1097/md.0000000000024327] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 12/20/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES In this study, a meta-analysis was conducted to evaluate the occult lymph node metastasis rate in patients with early-stage (T1-T2) oral tongue squamous cell carcinoma. Also, the correlation between occult lymph node metastasis rate and T2 ratio among T1-T2 or the reported year of each study was analyzed to adjust other confound variables. STUDY DESIGN Literature search. METHODS A systematic computerized search of the electronic databases was carried out for articles published between January 1, 1980, and December 31, 2018, which reported occult nodal metastasis rate in T1 and T2 (separately) tongue cancer patients. Statistical analysis was performed using Comprehensive Meta Analysis version 3.3.070. Publication bias was assessed by the Egger test and Begg funnel plot method. The correlation between occult nodal metastasis rate and T2 ratio or reported year, respectively, was assessed by meta-regression analysis. RESULTS From 19 studies, a total of 1567 cases were included in the meta-analysis. By random effects model, the mean occult cervical lymph node metastasis was 24.4% (95% confidence interval; 0.205-0.248). The meta-regression revealed that the T2 ratio and the reported year of the studies did not have a significant effect on the occult metastasis rate (correlation coefficient = 0.531 and 0.002, respectively, and P = .426 and 0.921, respectively). CONCLUSION The meta-analysis revealed that the early-stage oral tongue squamous cell carcinoma had a rate of 24.4% for occult nodal metastasis. The occult nodal metastasis rate was not significantly affected by neither T2 ratio among T1-T2 nor reported year of the studies.
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Cai H, Zhu Y, Wang C, Zhang Y, Hou J. Neck nodal recurrence and survival of clinical T1-2 N0 oral squamous cell carcinoma in comparison of elective neck dissection versus observation: A meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129:296-310. [DOI: 10.1016/j.oooo.2019.10.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/19/2019] [Accepted: 10/30/2019] [Indexed: 12/21/2022]
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Ibrahim SA, Ahmed ANA, Elsersy HA, Darahem IMH. Elective neck dissection in T1/T2 oral squamous cell carcinoma with N0 neck: essential or not? A systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2020; 277:1741-1752. [PMID: 32100133 DOI: 10.1007/s00405-020-05866-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/12/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Oral squamous cell carcinoma (SCC) is characterized by a high risk of cervical lymph node metastasis with a high incidence of occult metastasis. A strong debate is still present regarding the best treatment for early oral cavity cancer with N0 neck. OBJECTIVE The aim of the present study was to compare between the results of elective neck dissection (END) and watchful waiting (observation or therapeutic neck dissection) in patients with early-stage (T1/T2) oral squamous cell carcinoma with N0 neck. DATA SOURCES Medline database (https://www.pubmed.com), Google Scholar and Scopus. PATIENTS AND METHODS A systematic review and meta-analysis for the evaluation of regional recurrence rate and 5-year survival rate after elective neck dissection (END) or watchful waiting in early oral cancers were conducted. This study included published English medical articles (which met our predetermined inclusion criteria) in the last 30 years, concerning early oral SCC with N0 neck. 24 articles were included (4 randomized studies and 20 observational "retrospective" studies) with a total number of 2190 of patients who underwent END and 1619 who underwent watchful waiting. Regarding the 5-year survival rate, (10) studies were included with a total number of 1211 patients who underwent END and 948 who underwent watchful waiting. RESULTS Regarding the regional recurrence rate, (END) was associated with significantly lower risk of recurrence when compared with observation. Regarding the 5-year survival rate, END was associated with a better survival rate than the observational group. CONCLUSIONS Elective neck dissection is better than watchful waiting in early (T1/T2) stage oral cavity squamous cell carcinoma with N0 neck, regarding regional recurrence and 5-year survival rate.
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Affiliation(s)
- Samer Ahmed Ibrahim
- Department of Otorhinolaryngology, Faculty of Medicine, Ain Shams University, 6th Nile Valley Street, Hadayek Alkoba, Cairo, 11331, Egypt
| | - Ahmed Nabil Abdelhamid Ahmed
- Department of Otorhinolaryngology, Faculty of Medicine, Ain Shams University, 6th Nile Valley Street, Hadayek Alkoba, Cairo, 11331, Egypt.
| | - Hisham Abdelaty Elsersy
- Department of Otorhinolaryngology, Faculty of Medicine, Ain Shams University, 6th Nile Valley Street, Hadayek Alkoba, Cairo, 11331, Egypt
| | - Islam Mohammed Hussein Darahem
- Department of Otorhinolaryngology, Faculty of Medicine, Ain Shams University, 6th Nile Valley Street, Hadayek Alkoba, Cairo, 11331, Egypt
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Ariji Y, Fukuda M, Kise Y, Nozawa M, Nagao T, Nakayama A, Sugita Y, Katumata A, Ariji E. A preliminary application of intraoral Doppler ultrasound images to deep learning techniques for predicting late cervical lymph node metastasis in early tongue cancers. ACTA ACUST UNITED AC 2019. [DOI: 10.1002/osi2.1039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Yoshiko Ariji
- Department of Oral and Maxillofacial Radiology Aichi‐Gakuin University School of Dentistry Nagoya Japan
| | - Motoki Fukuda
- Department of Oral and Maxillofacial Radiology Aichi‐Gakuin University School of Dentistry Nagoya Japan
| | - Yoshitaka Kise
- Department of Oral and Maxillofacial Radiology Aichi‐Gakuin University School of Dentistry Nagoya Japan
| | - Michihito Nozawa
- Department of Oral and Maxillofacial Radiology Aichi‐Gakuin University School of Dentistry Nagoya Japan
| | - Toru Nagao
- Department of Maxillofacial Surgery Aichi‐Gakuin University School of Dentistry Nagoya Japan
| | - Atsushi Nakayama
- Department of Oral and Maxillofacial Surgery Aichi‐Gakuin University School of Dentistry Nagoya Japan
| | - Yoshihiko Sugita
- Department of Oral Pathology Aichi‐Gakuin University School of Dentistry Nagoya Japan
| | - Akitoshi Katumata
- Department of Oral Radiology Asahi University School of Dentistry Mizuho Japan
| | - Eiichiro Ariji
- Department of Oral and Maxillofacial Radiology Aichi‐Gakuin University School of Dentistry Nagoya Japan
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Hanai N, Asakage T, Kiyota N, Homma A, Hayashi R. Controversies in relation to neck management in N0 early oral tongue cancer. Jpn J Clin Oncol 2019; 49:297-305. [PMID: 30668761 DOI: 10.1093/jjco/hyy196] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/22/2018] [Accepted: 12/21/2018] [Indexed: 02/05/2023] Open
Abstract
The standard local treatment for early-stage tongue cancer with no clinical lymph node metastases is partial glossectomy. The frequency of occult lymph node metastasis is ~20-30%. Thus, whether prophylactic neck dissection with glossectomy or glossectomy alone should be performed has been a controversial issue since the 1980s. Both treatments have advantages and disadvantages; however, especially in cases involving prophylactic neck dissection, surgical invasion and complications including the cosmetic disadvantage caused by neck skin incision, accessory nerve paralysis or facial nerve (mandibular marginal branch) paralysis, stiffness of the shoulder or neck and a feeling of neck tightness have been considered issues that could be solved by providing less-invasive treatment to the 70-80% of patients without occult lymph node metastasis. A more accurate preoperative diagnosis and strict follow-up are required to provide minimally invasive treatment while ensuring the therapeutic effect. It is also necessary to narrow down the target based on the risk-benefit balance. The depth of invasion should be considered in cases involving oral cavity malignancies. This was also taken into account in recent revisions of eighth edition of the TNM Classification of Malignant Tumors and it is an important factor for N0 neck management. This review article summarizes previous and recent reports on neck management, focusing on the risk-benefit and future perspectives of the diagnosis and treatment of early-stage oral tongue cancer. This effort is an attempt to establish treatment from the patient's point of view, with the patient's quality of life taken into account.
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Affiliation(s)
- Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Aichi, Japan
| | - Takahiro Asakage
- Department of Head and Neck Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naomi Kiyota
- Department of Medical Oncology/Hematology and Cancer Center, Kobe University Hospital, Hyogo, Japan
| | - Akihiro Homma
- Department of Otolaryngology--Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Ryuichi Hayashi
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan
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Cao Y, Wang T, Yu C, Guo X, Li C, Li L. Elective Neck Dissection Versus Wait-and-Watch Policy for Oral Cavity Squamous Cell Carcinoma in Early Stage: A Systematic Review and Meta-Analysis Based on Survival Data. J Oral Maxillofac Surg 2019; 77:2154-2167. [PMID: 31014965 DOI: 10.1016/j.joms.2019.03.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 03/16/2019] [Accepted: 03/16/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE Whether elective neck dissection (END) should be adopted for patients with clinically early-stage (cT1-2N0M0) oral cavity squamous cell carcinoma (OCSCC) remains debated. The aim of this systematic review was to compare the survival benefit of END with that of the wait-and-watch policy (WW) for patients with early-stage OCSCC based on survival data. MATERIALS AND METHODS According to the inclusion criteria, an exhaustive search for eligible studies was conducted. The study inclusion and data extraction were performed by 2 reviewers independently. The risk of bias was assessed in duplicate using the Risk Of Bias In Nonrandomized Studies of Interventions instrument. The hazard ratio (HR) of the time-to-event data was extracted or estimated. RevMan 5.3 and STATA 15.1 were adopted for data synthesis. RESULTS Of the 35 studies that were included, only 5 were assessed as having a low risk of bias. Results of the meta-analyses showed END could significantly decrease neck recurrence (relative risk = 0.45; confidence interval [CI], 0.35-0.59; P < .00001) and improve disease-free survival (HR = 0.55; CI, 0.42-0.71; P < .00001), overall survival (HR = 0.75; CI, 0.64-0.86; P < .0001), and disease-specific survival (HR = 0.76; CI, 0.61-0.94; P = .01) compared with WW for patients with cT1-2N0. The subgroup analysis showed that END could decrease neck recurrence (P < .00001) and improve disease-free survival (P = .001) for patients with early-stage tongue cancer and that supraomohyoid neck dissection could decrease neck recurrence (P = .02). For patients with cT1N0, END could significantly decrease the proportion with neck recurrence (P = .0008) and improve disease-free survival (P = .0003), but the difference between overall survival and disease-specific survival did not achieve significance. CONCLUSIONS END can decrease recurrence and improve survival time for patients with early-stage OCSCC. More high-quality studies are needed to make a solid conclusion, especially for patients with cT1N0M0.
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Affiliation(s)
- Yubin Cao
- PhD Candidate, Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
| | - Tao Wang
- PhD Candidate, Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
| | - Changhao Yu
- PhD Candidate, State Key Laboratory of Oral Diseases, West China College of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
| | - Xia Guo
- Associate Professor, College of Foreign Languages and Cultures, Sichuan University, Chengdu, China
| | - Chunjie Li
- Associate Professor, Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China.
| | - Longjiang Li
- Professor, Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
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Hingsammer L, Seier T, Ikenberg J, Schumann P, Zweifel D, Rücker M, Bredell M, Lanzer M. The influence of lymph node ratio on survival and disease recurrence in squamous cell carcinoma of the tongue. Int J Oral Maxillofac Surg 2019; 48:851-856. [PMID: 30738712 DOI: 10.1016/j.ijom.2019.01.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/20/2018] [Accepted: 01/11/2019] [Indexed: 11/16/2022]
Abstract
This study was performed to report the outcomes of patients with oral squamous cell carcinoma (OSCC) of the tongue over a 10-year period with the aim of testing the hypothesis that the lymph node ratio (LNR) has a significant influence on loco-regional recurrence. The charts of 227 patients with OSCC of the mobile tongue treated at the University Hospital of Zurich from 2003 to 2012 were screened. Following the application of the exclusion criteria (prior chemotherapy, radiotherapy, or surgery, perioperative death, N3 disease, unresectable disease, synchronous second primary, no signed informed consent, and follow-up <3years), prospective data were collected and a retrospective analysis performed for 88 of these patients who were treated with selective neck dissection. During a mean follow-up period of 78 months (standard deviation 37 months), loco-regional recurrence was diagnosed in 25 patients (28%). The overall and disease-specific survival rates for the study population were 72% and 80%, respectively. Perineural invasion was identified as an independent risk factor for decreased disease-specific survival, whereas LNR was not. LNR did not show an influence on disease recurrence. Thus, its prognostic value in patients with tongue cancer remains uncertain and the decision regarding adjuvant therapy should not be made solely on the basis of LNR.
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Affiliation(s)
- L Hingsammer
- Department of Cranio-Maxillo-Facial and Oral Surgery, University Hospital of Zurich, Zurich, Switzerland.
| | - T Seier
- Department of Cranio-Maxillo-Facial and Oral Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - J Ikenberg
- Institute of Pathology and Molecular Pathology, University Hospital of Zurich, Zurich, Switzerland
| | - P Schumann
- Department of Cranio-Maxillo-Facial and Oral Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - D Zweifel
- Department of Cranio-Maxillo-Facial and Oral Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - M Rücker
- Department of Cranio-Maxillo-Facial and Oral Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - M Bredell
- Department of Cranio-Maxillo-Facial and Oral Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - M Lanzer
- Department of Cranio-Maxillo-Facial and Oral Surgery, University Hospital of Zurich, Zurich, Switzerland
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Hingsammer L, Seier T, Zweifel D, Huber G, Rücker M, Bredell M, Lanzer M. Sentinel lymph node biopsy for early stage tongue cancer-a 14-year single-centre experience. Int J Oral Maxillofac Surg 2018; 48:437-442. [PMID: 30389112 DOI: 10.1016/j.ijom.2018.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 02/05/2023]
Abstract
This study was performed to report the usage of sentinel lymph node biopsy (SLNB) in clinical stage I or II tongue cancer patients with cN0 necks seen over a 14-year period. Data were collected prospectively, and a retrospective analysis was performed of 41 patients with early stage oral squamous cell carcinoma of the tongue and a cN0 neck. Sentinel lymph node (SLN)-positive patients underwent elective neck dissection, whereas SLN-negative patients were kept under careful observation. Seven of the 41 (17%) patients enrolled in the study were found to have occult metastases. The patients were followed up for a mean duration of 92 months (range 60-144 months). The neck recurrence rate for SLN-positive patients was 0% and for SLN-negative patients was 3%. The authors recommend the routine use of SLNB in patients with early stage oral squamous cell carcinoma of the tongue and a cN0 neck. Furthermore, special focus should be placed on isolated tumour cells, as their presence is of high clinical relevance.
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Affiliation(s)
- L Hingsammer
- Department of Oral and Maxillofacial Surgery, University Clinic of Zurich, Zurich, Switzerland.
| | - T Seier
- Department of Oral and Maxillofacial Surgery, University Clinic of Zurich, Zurich, Switzerland
| | - D Zweifel
- Department of Oral and Maxillofacial Surgery, University Clinic of Zurich, Zurich, Switzerland
| | - G Huber
- Department of Ear, Nose and Throat, University Clinic of Zurich, Zurich, Switzerland
| | - M Rücker
- Department of Oral and Maxillofacial Surgery, University Clinic of Zurich, Zurich, Switzerland
| | - M Bredell
- Department of Oral and Maxillofacial Surgery, University Clinic of Zurich, Zurich, Switzerland
| | - M Lanzer
- Department of Oral and Maxillofacial Surgery, University Clinic of Zurich, Zurich, Switzerland
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Tsai MS, Lai CH, Lee CP, Yang YH, Chen PC, Kang CJ, Chang GH, Tsai YT, Lu CH, Chien CY, Young CK, Fang KH, Liu CJ, Yeh RMA, Chen WC. Mortality in tongue cancer patients treated by curative surgery: a retrospective cohort study from CGRD. PeerJ 2016; 4:e2794. [PMID: 27994985 PMCID: PMC5162395 DOI: 10.7717/peerj.2794] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/14/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Our study aimed to compare the outcomes of surgical treatment of tongue cancer patients in three different age groups. METHODS From 2004 to 2013, we retrospectively analyzed the clinical data of 1,712 patients who were treated in the four institutions constituting the Chang Gung Memorial Hospitals (CGMH). We divided and studied the patients in three age groups: Group 1, younger (<65 years); Group 2, young old (65 to <75); and Group 3, older old patients (≥75 years). RESULTS Multivariate analyses determined the unfavorable, independent prognostic factors of overall survival to be male sex, older age, advanced stage, advanced T, N classifications, and surgery plus chemotherapy. No significant differences were found in adjusted hazard ratios (HR) of death in early-stage disease (stage I-II) among Group 1 (HR 1.0), Group 2 (HR 1.43, 95% confidence interval (CI) [0.87-2.34], p = 0.158), and Group 3 (HR 1.22, 95% CI [0.49-3.03], p = 0.664) patients. However, amongst advanced-stage patients (stage (III-IV)), Group 3 (HR 2.53, 95% CI [1.46-4.38], p = 0.001) showed significantly worse survival than the other two groups after other variables were adjusted for. Fourteen out of 21 older old, advanced-staged patients finally died, and most of the mortalities were non-cancerogenic (9/14, 64.3%), and mostly occurred within one year (12/14, 85%) after cancer diagnosis. These non-cancer cause of death included underlying diseases in combination with infection, pneumonia, poor nutrition status, and trauma. CONCLUSIONS Our study showed that advanced T classification (T3-4), positive nodal metastasis (N1-3) and poorly differentiated tumor predicted poor survival for all patients. Outcome of early-stage patients (stage I-II) among three age groups were not significantly different. However, for advanced-stage patients (stage III-IV), the older old patients (≥75) had significantly worse survival than the other two patient groups. Therefore, for early-stage patients, age should not deny them to receive optimal treatments. However, older old patients (≥75) with advanced cancer should be comprehensively assessed by geriatric tools before surgical treatment and combined with intensive postoperative care to improve outcome, especially the unfavorable non-cancerogenic mortalities within one year after cancer diagnosis.
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Affiliation(s)
- Ming-Shao Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; Center of Excellence for Chang Gung Research Datalink, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chia-Hsuan Lai
- Department of Radiation Oncology, Chiayi Chang Gung Memorial Hospital , Chiayi , Taiwan
| | - Chuan-Pin Lee
- Center of Excellence for Chang Gung Research Datalink, Chiayi Chang Gung Memorial Hospital , Chiayi , Taiwan
| | - Yao-Hsu Yang
- Center of Excellence for Chang Gung Research Datalink, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pau-Chung Chen
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Jan Kang
- Department of Otolaryngology -Head and Neck Surgery, Linkou Chang Gung Memorial Hospital , Taoyuan , Taiwan
| | - Geng-He Chang
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital , Chiayi , Taiwan
| | - Yao-Te Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital , Chiayi , Taiwan
| | - Chang-Hsien Lu
- Department of Medical Oncology, Chiayi Chang Gung Memorial Hospital , Chiayi , Taiwan
| | - Chih-Yen Chien
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital , Kaohsiung , Taiwan
| | - Chi-Kuang Young
- Department of Otolaryngology -Head and Neck Surgery, Keelung Chang Gung Memorial Hospital , Keelung , Taiwan
| | - Ku-Hao Fang
- Department of Otolaryngology -Head and Neck Surgery, Linkou Chang Gung Memorial Hospital , Taoyuan , Taiwan
| | - Chin-Jui Liu
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital , Chiayi , Taiwan
| | - Re-Ming A Yeh
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital , Chiayi , Taiwan
| | - Wen-Cheng Chen
- Center of Excellence for Chang Gung Research Datalink, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Radiation Oncology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
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15
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Impact of metronomic neoadjuvant chemotherapy on early tongue cancer. Cancer Chemother Pharmacol 2016; 78:833-40. [DOI: 10.1007/s00280-016-3141-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
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16
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Miura K, Hirakawa H, Uemura H, Yoshimoto S, Shiotani A, Sugasawa M, Homma A, Yokoyama J, Tsukahara K, Yoshizaki T, Yatabe Y, Matsuo K, Ohkura Y, Kosuda S, Hasegawa Y. Sentinel node biopsy for oral cancer: A prospective multicenter Phase II trial. Auris Nasus Larynx 2016; 44:319-326. [PMID: 27496008 DOI: 10.1016/j.anl.2016.07.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 06/30/2016] [Accepted: 07/12/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE A recent study identified a survival benefit with prophylactic neck dissection (ND) at the time of primary surgery as compared with watchful waiting followed by therapeutic neck dissection for nodal relapse, in patients with cN0 oral squamous cell carcinoma (OSCC). Alternative management of cN0 neck cancer is recommended to minimize the adverse effects of ND, indicating the need for sentinel node biopsy (SNB) and limited neck dissection. We conducted a multicenter Phase II study to examine the feasibility of SNB for clinically N0 OSCC. METHODS Previously untreated N0 OSCC patients (n=57) with clinical late-T2 or T3 tumors were enrolled across 10 institutions. SNB navigated with multislice frozen section analysis of sentinel nodes (SNs) and SNB supported sentinel node lymphatic basin dissection (SN basin dissection) were performed in a one-stage procedure. The endpoint was to investigate the rate of false-negative metastases after SN basin dissection and SNB alone. RESULTS Most tumors were late-T2 lesions (n=50; 87.7%). SNs were identified in all patients. A total of 196 SNs were detected. Among these SNs, 35 (17.8%) were positive for metastasis (9 in level I, 12 in level II, 12 in level III, 1 in level V and 2 in the contralateral region of the neck). The false-negative rate of SNB supported by SN basin dissection and SNB alone was 4.5% and 9.1%, respectively. The concordance of the SN status in intraoperative frozen sections with the permanent histopathology was 97.4% (191/196). The sensitivity and specificity of intraoperative pathological evaluation were 85.7% (30/35) and 100% (30/30), respectively. The 3-year overall survival (OS) and disease-free survival was 89.5% and 82.5%, respectively. The OS of SN-negative patients was significantly longer than that of SN-positive patients (P=0.047). CONCLUSION The current study verified that SN basin dissection was a useful back-up procedure for SNB performed as a one-stage procedure, showing a low false-negative rate. SNB alone is an appropriate staging method for patients with clinical N0 staging, and a reliable procedure to determine the appropriate levels for neck dissection.
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Affiliation(s)
- Kouki Miura
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, Tokyo 108-8329, Japan
| | - Hitoshi Hirakawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan; Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 903-0213 Okinawa, Japan
| | - Hirokazu Uemura
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara 634-8521, Japan
| | - Seiichi Yoshimoto
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Akihiro Shiotani
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Masashi Sugasawa
- Department of Head and Neck Surgery, Saitama Medical University International Medical Center, Saitama 350-1298, Japan
| | - Akihiro Homma
- Department of Otolaryngology, Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Junkichi Yokoyama
- Department of Otolaryngology, Head and Neck Surgery, Moriyama Memorial Hospital, Tokyo 134-0088, Japan
| | - Kiyoaki Tsukahara
- Department of Otolaryngology - Head and Neck Surgery, Tokyo Medical University Hospital, Tokyo 160-0022, Japan
| | - Tomokazu Yoshizaki
- Division of Otolaryngology, Head and Neck Surgery, Graduate School of Medical Science, Kanazawa University 920-0942, Kanazawa, Japan
| | - Yasushi Yatabe
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Keitaro Matsuo
- Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya 464-8681, Japan
| | - Yasuo Ohkura
- Department of Pathology, Kyorin University School of Medicine, Tokyo 181-8612, Japan
| | - Shigeru Kosuda
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University School of Medicine, Maebashi 371-8511, Japan
| | - Yasuhisa Hasegawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan.
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Seki M, Sano T, Yokoo S, Oyama T. Histologic assessment of tumor budding in preoperative biopsies to predict nodal metastasis in squamous cell carcinoma of the tongue and floor of the mouth. Head Neck 2015; 38 Suppl 1:E1582-90. [PMID: 26595238 DOI: 10.1002/hed.24282] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 08/13/2015] [Accepted: 09/12/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND In squamous cell carcinoma (SCC) of the tongue and the floor of the mouth (FOM), it is important to predict lymph node metastasis, including occult metastasis, before operating. The purpose of this study was for us to determine practical histopathologic parameters as predictive factors for lymph node metastasis in preoperative SCC biopsy specimens. METHODS We examined 91 cases of SCC for conventional histopathologic assessment and a new factor, tumor budding, and their relationship with lymph node metastasis. RESULTS Significant factors via univariate analysis (p < .01) were budding (score ≥3) and tumor depth (≥3 mm) and these were associated with lymph node metastasis. Moreover, both budding and tumor depth significantly correlated with relapse-free survival; however, evaluating biopsy specimens often proved inaccurate for predicting true tumor depth of cancer invasion. CONCLUSION Tumor budding using immunohistochemistry for cytokeratin should be added to routine histologic assessments as a new criterion factoring into the decision as to whether neck dissection is indicated. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1582-E1590, 2016.
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Affiliation(s)
- Mai Seki
- Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.,Department of Stomatology and Maxillofacial Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takaaki Sano
- Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Satoshi Yokoo
- Department of Stomatology and Maxillofacial Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tetsunari Oyama
- Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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18
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Habu N, Imanishi Y, Kameyama K, Shimoda M, Tokumaru Y, Sakamoto K, Fujii R, Shigetomi S, Otsuka K, Sato Y, Watanabe Y, Ozawa H, Tomita T, Fujii M, Ogawa K. Expression of Oct3/4 and Nanog in the head and neck squamous carcinoma cells and its clinical implications for delayed neck metastasis in stage I/II oral tongue squamous cell carcinoma. BMC Cancer 2015; 15:730. [PMID: 26483189 PMCID: PMC4610045 DOI: 10.1186/s12885-015-1732-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 10/08/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The side population (SP) of cancer cells is reportedly enriched with cancer stem cells (CSCs), however, the functional role and clinical relevance of CSC marker molecules upregulated in the SP of head and neck squamous carcinoma (HNSCC) cells are yet to be elucidated. Patients with clinical stage I/II (T1-2N0M0) tongue squamous cell carcinoma (TSCC) typically undergo partial glossectomy; however, development of delayed neck metastasis (DNM) tends to reduce their survival. In the present study, we aimed to determine the CSC markers in the SP of HNSCC cells along with their functions in cellular behaviors, and to clarify the association of these markers with DNM. METHODS Flow cytometry was applied to isolate SP from main population (MP) in HNSCC cells. The expression of the CSC markers was examined by semi-quantitative RT-PCR and immunocytochemistry. In vitro proliferation, migration, and invasion assays were performed to assess cellular behaviors. Clinicopathological factors and immunohistochemical expressions of Oct3/4 and Nanog were evaluated using surgical specimens from 50 patients with stage I/II TSCC. RESULTS SPs were isolated in all three cell lines examined. Expression levels of Oct3/4 and Nanog were higher in SP cells than MP cells. Additionally, cell migration and invasion abilities were higher in SP cells than MP cells, whereas there was no difference in proliferation. Univariate analysis showed that expression of Oct3/4 and Nanog, vascular and muscular invasion, and mode of invasion were significantly correlated with DNM. Multivariate logistic regression revealed that Oct3/4 expression (risk ratio = 14.78, p = 0.002) and vascular invasion (risk ratio = 12.93, p = 0.017) were independently predictive of DNM. Regarding the diagnostic performance, Oct3/4 showed the highest accuracy, sensitivity, and NPV of 82.0 %, 61.5 %, and 86.8 %, respectively, while vascular invasion showed the highest specificity and PPV of 94.6 % and 71.4 %, respectively. CONCLUSION These results suggest that Oct3/4 and Nanog represent probable CSC markers in HNSCC, which contribute to the development of DNM in part by enhancing cell motility and invasiveness. Moreover, along with vascular invasion, expression of Oct3/4 can be considered a potential predictor for selecting patients at high risk of developing DNM.
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Affiliation(s)
- Noboru Habu
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, 160-8582, Shinjuku, Tokyo, Japan. .,Department of Otorhinolaryngology, Tachikawa Hospital, Tokyo, Japan.
| | - Yorihisa Imanishi
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, 160-8582, Shinjuku, Tokyo, Japan.
| | - Kaori Kameyama
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan.
| | - Masayuki Shimoda
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan.
| | - Yutaka Tokumaru
- Department of Otorhinolaryngology, National Tokyo Medical Center, Tokyo, Japan.
| | - Koji Sakamoto
- Department of Otorhinolaryngology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan.
| | - Ryoichi Fujii
- Department of Otorhinolaryngology, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan.
| | - Seiji Shigetomi
- Department of Otorhinolaryngology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan.
| | - Kuninori Otsuka
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, 160-8582, Shinjuku, Tokyo, Japan.
| | - Yoichiro Sato
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, 160-8582, Shinjuku, Tokyo, Japan.
| | - Yoshihiro Watanabe
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, 160-8582, Shinjuku, Tokyo, Japan.
| | - Hiroyuki Ozawa
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, 160-8582, Shinjuku, Tokyo, Japan.
| | - Toshiki Tomita
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, 160-8582, Shinjuku, Tokyo, Japan.
| | - Masato Fujii
- National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo, Japan.
| | - Kaoru Ogawa
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, 160-8582, Shinjuku, Tokyo, Japan.
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Ren ZH, Wu HJ, Zhang S, Wang K, Gong ZJ, He ZJ, Peng J. A new surgical strategy for treatment of tongue squamous cell carcinoma based on anatomic study with preliminary clinical evaluation. J Craniomaxillofac Surg 2015; 43:1577-82. [PMID: 26321124 DOI: 10.1016/j.jcms.2015.07.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 07/17/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND This study characterized the infiltration of primary tumors along the intrinsic and extrinsic muscles of the tongue in oral tongue squamous cell carcinoma (OTSCC), to create a new surgical strategy that is suitable for most stages. A preliminary evaluation of this novel surgical approach was also conducted. METHODS An anatomic study of macroscopic specimens from 10 human cadavers and 100 OTSCC patients was conducted. The anatomic characteristics of the primary tumors and the origin and distribution of fibers of the intrinsic and extrinsic tongue muscles were observed and measured. After initial treatment with curative intent, the 100 patients were regularly followed-up with clinical examination and imaging. RESULT Based on the anatomic characteristics of the primary tumors and tongue muscles, a new surgical approach was developed, and was described as muscle anatomy tongue surgery (MATS). MATS proved suitable for almost all stages of OTSCC. According to the morphology of the invasive tumor front, the 100 cases were divided into four types. The rate of 2-year local disease control was 98%, locoregional control 86%, disease-free survival 85%, and overall survival 89%. Tongue functions were perfectly recovered in more than 60% of the patients. CONCLUSION Application of the principles of MATS to the treatment of OTSCC proved suitable for almost all stages of the disease. MATS is a novel surgical technique that may improve outcomes in tongue cancer surgery.
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Affiliation(s)
- Zhen-Hu Ren
- Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China; Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China.
| | - Han-Jiang Wu
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China.
| | - Sheng Zhang
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China
| | - Kai Wang
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China
| | - Zhao-Jian Gong
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China
| | - Zhi-Jing He
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China
| | - Jie Peng
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China
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20
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Expression of myeloid zinc finger 1 and the correlation to clinical aspects of oral squamous cell carcinoma. Tumour Biol 2015; 36:7099-105. [DOI: 10.1007/s13277-015-3419-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 03/31/2015] [Indexed: 01/14/2023] Open
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21
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Role of intraoral color Doppler sonography in predicting delayed cervical lymph node metastasis in patients with early-stage tongue cancer: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:246-53. [DOI: 10.1016/j.oooo.2014.10.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 08/13/2014] [Accepted: 10/29/2014] [Indexed: 01/15/2023]
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22
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Goto M, Hanai N, Ozawa T, Hirakawa H, Suzuki H, Hyodo I, Kodaira T, Ogawa T, Fujimoto Y, Terada A, Kato H, Hasegawa Y. Prognostic factors and outcomes for salvage surgery in patients with recurrent squamous cell carcinoma of the tongue. Asia Pac J Clin Oncol 2013; 12:e141-8. [DOI: 10.1111/ajco.12087] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mitsuo Goto
- Department of Oral and Maxillofacial Surgery; Aichi Gakuin University
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery; Aichi Cancer Center
| | - Taijiro Ozawa
- Department of Head and Neck Surgery; Aichi Cancer Center
| | | | | | - Ikuo Hyodo
- Department of Plastic and Reconstructive Surgery; Aichi Cancer Center
| | - Takeshi Kodaira
- Department of Therapeutic Radiation Oncology; Aichi Cancer Center
| | - Tetsuya Ogawa
- Department of Otorhinolaryngology; Aichi Medical University School of Medicine; Nagakute
| | - Yasushi Fujimoto
- Department of Otolaryngology; Nagoya University Graduate School of Medicine
| | - Akihiro Terada
- Department of Otorhinolaryngology; Japanese Red Cross Nagoya Daiichi Hospital; Nagoya
| | - Hisakazu Kato
- Division of Plastic and Reconstructive Surgery; Department of Otolaryngology; Gifu University Hospital; Gifu Japan
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Yanamoto S, Yamada SI, Takahashi H, Kawasaki G, Ikeda H, Shiraishi T, Fujita S, Ikeda T, Asahina I, Umeda M. Predictors of locoregional recurrence in T1-2N0 tongue cancer patients. Pathol Oncol Res 2013; 19:795-803. [PMID: 23677778 DOI: 10.1007/s12253-013-9646-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 04/24/2013] [Indexed: 01/15/2023]
Abstract
Locoregional recurrence of oral tongue squamous cell carcinoma (OTSCC) has been considered a poor prognostic entity in terms of survival rate. The purpose of this study was to evaluate the incidence of locoregional recurrence and to identify significant risk factors for locoregional recurrence in early-stage OTSCC. We retrospectively reviewed the records of 58 patients who underwent radical surgery for T1-2N0 OTSCC. The local recurrence and regional recurrence rates were 10.3 % (6/58 patients) and 15.5 % (9/58 patients) in this study, respectively. The survival rate of patients with local recurrence was 66.7 %, which was significantly lower than that (96.2 %) of patients without local recurrence, whereas the survival rates of patients with or without regional recurrence were not significantly difference. Pattern of invasion (POI), neoadjuvant chemotherapy (NAC) and the status of the surgical margin were identified as factors influencing local recurrence. In particular, the status of the deep surgical margin was a high potential independent risk factor. The deep surgical margin was resected closely in many NAC-treated cases, suggesting that NAC may lead to local recurrence and a poor outcome. No efficacy of NAC was observed, suggesting that the standard treatment for early OTSCC is surgery alone.
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Affiliation(s)
- Souichi Yanamoto
- Department of Clinical Oral Oncology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan,
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Sakamoto K, Imanishi Y, Tomita T, Shimoda M, Kameyama K, Shibata K, Sakai N, Ozawa H, Shigetomi S, Fujii R, Fujii M, Ogawa K. Overexpression of SIP1 and downregulation of E-cadherin predict delayed neck metastasis in stage I/II oral tongue squamous cell carcinoma after partial glossectomy. Ann Surg Oncol 2011; 19:612-9. [PMID: 21913013 DOI: 10.1245/s10434-011-2052-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Indexed: 01/14/2023]
Abstract
BACKGROUND Patients with clinical stage I/II (T1-2N0M0) oral tongue squamous cell carcinoma (TSCC) usually undergo partial glossectomy alone. However, 14-48% of them develop delayed neck metastasis (DNM), which may lead to an unfavorable course. Recently epithelial-to-mesenchymal transition (EMT) has been thought to play a crucial role in cancer metastasis. The present study aimed to examine the associations of EMT-involved molecular factors and clinicopathological factors with DNM in stage I/II TSCC. METHODS mRNA expression levels of E-cadherin and its transcriptional repressors (snail, SIP1, and twist) in 7 head and neck squamous cell carcinoma (HNSCC) cell lines were evaluated by quantitative real-time PCR. Clinicopathological parameters and immunohistochemical expressions of E-cadherin and its repressors were examined in surgical specimens of 37 stage I/II TSCC patients who underwent partial glossectomy alone. RESULTS In HNSCC cells, E-cadherin expression was inversely correlated with SIP1 expression (P = 0.023). Univariate analysis of immunohistochemistry showed that overexpression of SIP1 and loss of E-cadherin were significantly correlated with DNM, although no inverse correlation was found between E-cadherin and its repressors. Multiple logistic regression analysis including clinicopathological and molecular factors revealed that overexpression of SIP1 (P = 0.005), loss of E-cadherin (P = 0.046), and vascular invasion (P = 0.024) were independently correlated with DNM. CONCLUSIONS These results suggest that development of DNM in stage I/II TSCC is closely related to induction of EMT in primary tumor cells. Especially, SIP1 and E-cadherin are considered to be the possible markers for selecting patients at high risk of DNM.
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Affiliation(s)
- Koji Sakamoto
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
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Zhang B, Huang HZ, Pan CB, Xu JH, Wang JG, Chen WL. Aesthetic and functional radical surgery in young patients with stage one or two tongue cancer: a preliminary report. J Craniomaxillofac Surg 2010; 39:209-14. [PMID: 20417110 DOI: 10.1016/j.jcms.2010.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2009] [Revised: 12/14/2009] [Accepted: 03/09/2010] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION The effect of an initial radical cure and the post-operative quality of life in young patients with stage one or two tongue cancer seems to be more important than in old patients. The aim of this study was to achieve both optimal surgical effectiveness and improved post-operative quality of life for young patients with stage one or two tongue cancer. MATERIALS AND METHODS 7 patients under 40 years of age with T(1)-T(2)N(0)M(0) squamous cell carcinoma of tongue underwent aesthetic and functional radical surgery in which reconstruction of the defect in the oral cavity and conservation of the main functional organs in neck with good scar aesthetics in the face and neck were performed. The outcomes were assessed clinically. RESULTS No tumour recurrence was found in the tongue, floor of mouth or neck at the end of follow-up (at least 37 months). The appearance of the tongue and oral function was retained; function in face, neck and shoulder was maintained; a satisfactory cosmetic appearance of the face and neck was achieved. CONCLUSIONS Aesthetic and functional radical surgery could ensure radical cure and unchanged, or improved post-operative, quality of life in young patients with stage one or two tongue cancer.
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Affiliation(s)
- Bin Zhang
- Department of Oral and Maxillofacial Surgery, The Second Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China.
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Okura M, Aikawa T, Sawai NY, Iida S, Kogo M. Decision analysis and treatment threshold in a management for the N0 neck of the oral cavity carcinoma. Oral Oncol 2009; 45:908-11. [PMID: 19457712 DOI: 10.1016/j.oraloncology.2009.03.013] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Revised: 03/26/2009] [Accepted: 03/26/2009] [Indexed: 11/28/2022]
Abstract
The optimal method of management of clinical N0 neck in squamous cell carcinoma of the oral cavity remains controversial. We used decision analysis to determine the current optimal strategy in comparison with observation of the neck and elective neck dissection. A total of 165 previously untreated patients with N0 classification were investigated. Probabilities of each recurrence were calculated and probabilities of being cured in each event were substituted with the 5-year overall survival calculation with Kaplan-Meier method. A sensitivity analysis was performed to determine the optimal threshold for treatment of the N0 neck. The threshold of N0 neck was calculated using the formula with putting the three probabilities of being cured. In this study the threshold was estimated at 44.4%. N0 neck of squamous cell carcinoma of the oral cavity should be observed if the probability of occult metastasis is less than 44.4%. Proper calculation of three probabilities of being cured in each institution will make a decision of the optimal method of clinical N0 neck by using the threshold formula.
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Affiliation(s)
- Masaya Okura
- The First Department of Oral and Maxillofacial Surgery, Osaka University Dental Hospital, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan.
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Suzuki H, Hasegawa Y, Terada A, Hyodo I, Nakashima T, Nishio M, Tamaki T. FDG-PET predicts survival and distant metastasis in oral squamous cell carcinoma. Oral Oncol 2008; 45:569-73. [PMID: 18804407 DOI: 10.1016/j.oraloncology.2008.07.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Revised: 06/02/2008] [Accepted: 07/21/2008] [Indexed: 11/30/2022]
Abstract
High [(18)F]-2-fluorodeoxyglucose (FDG)-uptake of primary tumor, assessed by pretreatment positron emission tomography (PET), shows poor overall survival of patients after several therapies in various cancers. An association between FDG-uptake and distant metastasis-free survival in oral squamous cell carcinoma (OSCC) has not been assessed so far. An objective of this study is to investigate an association between FDG-uptake and overall survival of OSCC patients, and to ask whether FDG-uptake is related with distant metastasis-free survival in OSCC. Twenty-four patients who underwent both pretreatment FDG-PET and radical surgery without preoperative therapy were enrolled. We used the maximum standardized uptake value (SUVmax) as FDG-uptake. Overall survival, locoregional recurrence-free survival and distant metastasis-free survival were analyzed by Kaplan-Meier method. In univariate survival analysis, patients with SUVmax>or=12 exhibited significance in both shorter 3-year overall survival (p<0.01) and distant metastasis-free survival (p<0.04) than patients with SUVmax<12. Moreover, by Cox proportional hazards model of multivariate analysis, SUVmax>or=12 was found to be independent of clinical T and N categories, and exhibited significance in both shorter 3-year overall survival (p<0.02) and distant metastasis- free survival (p<0.05) than patients with SUVmax<12. These results suggest that pretreatment FDG-PET is able to provide both non-invasive and effective information for identifying a high- or low-risk group of OSCC patients with distant metastasis.
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Affiliation(s)
- Hidenori Suzuki
- Department of Head and Neck Surgery, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan
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Furusawa J, Oridate N, Suzuki F, Homma A, Furuta Y, Fukuda S. Initial CT findings in early tongue and oral floor cancer as predictors of late neck metastasis. Oral Oncol 2008; 44:793-7. [PMID: 18206418 DOI: 10.1016/j.oraloncology.2007.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2007] [Revised: 10/10/2007] [Accepted: 10/10/2007] [Indexed: 11/18/2022]
Abstract
Detecting the risk factors for late neck metastasis (LNM) in early tongue and oral floor cancer is important for establishing an accurate prognosis, as well as for increasing survival rates. Patients with either stage I or II tongue and oral floor cancer underwent either a resection of the primary tumor or interstitial radiotherapy without neck dissection. We measured the short- and long-axis diameters of lymph nodes on initial CT images. Of the 38 patients, 20 had LNM and 18 did not. CT images showed a total of 161 lymph nodes. Twenty-five "occult lymph nodes" developed into LNM, whereas the remaining 136 "reactive lymph nodes" did not. Comparison between "occult" and "reactive" lymph nodes revealed significant differences in the short-axis diameters (p=0.01). The measure of short-axis diameters of neck lymph nodes on initial CT images is a useful predictor of LNM in patients with early tongue and oral floor cancer.
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Affiliation(s)
- Jun Furusawa
- Department of Otolaryngology - Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo 060-8638, Japan
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Capote A, Escorial V, Muñoz-Guerra MF, Rodríguez-Campo FJ, Gamallo C, Naval L. Elective neck dissection in early-stage oral squamous cell carcinoma--does it influence recurrence and survival? Head Neck 2007; 29:3-11. [PMID: 17103411 DOI: 10.1002/hed.20482] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND This study investigates the influence on survival and regional control rates of neck dissection therapy at the time of surgery of the primary tumor in early stages of squamous cell carcinoma (SCC) of the oral cavity. METHODS A series of 154 patients with pT1N0M0 and pT2N0M0 intraoral carcinomas was analyzed retrospectively. Neck dissection was associated with tumor ablation in 87 patients (56.5%), although 67 patients (43.5%) were treated with local resection exclusively. Survival and relapse rates were studied with the Kaplan-Meier curves and the log-rank test for univariate analysis and Cox proportional model for multivariate analysis (p < .05). RESULTS Regional recurrences occurred in 25 cases (16.2%), 7 cases (8%) with primary neck dissection and 18 cases (26.8%) with local excision alone. Neck dissection therapy was a significant prognostic factor for recurrences and survival (p < .05). The 5-year regional control rate was of 92.5% for patients with elective lymph node ablation versus 71.2% for patients without primary neck dissection. Neck dissection was also significant for recurrences in stage I and for survival and recurrences in stage II. Neck dissection therapy also showed independent prognostic value in the Cox analysis. CONCLUSIONS In patients with intraoral carcinomas, elective neck treatment should be considered even in cases with a small primary tumor and negative clinical examination because of the high incidence of occult nodal metastases and the tendency to regional recurrences.
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Affiliation(s)
- Ana Capote
- Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, Universidad Autonoma of Madrid, Spain.
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Cho JH, Kim HS, Park CS, Kim JK, Jung KY, Shin BK, Kim HK. Maspin expression in early oral tongue cancer and its relation to expression of mutant-type p53 and vascular endothelial growth factor (VEGF). Oral Oncol 2007; 43:272-7. [PMID: 17174141 DOI: 10.1016/j.oraloncology.2006.03.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Revised: 03/18/2006] [Accepted: 03/20/2006] [Indexed: 10/23/2022]
Abstract
Even though oral tongue cancer is generally diagnosed at an early stage, the prognosis is poor due to frequent recurrence. Therefore, it is important to identify factors predictive of recurrence and to treat aggressively those patients with a high probability of recurrence. The relationship between angiogenesis and recurrence in tongue cancer has been widely investigated but no consensus has been reached. Mutant-type p53 and VEGF are known to be related to angiogenesis, and maspin is a potent angiogenic inhibitor but its role in tongue cancer has scarcely been examined. We observed the expression of maspin, mutant-type p53 and VEGF by immunohistochemistry in 33 patients with stages I and II oral tongue cancer. And the relationships between maspin, mutant-type p53, VEGF expression and recurrence were analyzed. Maspin and VEGF displayed a cytoplasmic staining pattern and mutant-type p53 a nuclear pattern. None of expression of maspin, mutant-type p53, and VEGF was significantly correlated with tumor recurrence (p=0.34, 0.56, and 0.33, respectively) and survival. Maspin expression was negatively correlated with both mutant-type p53 expression (p=0.02), and VEGF expression (p=0.01). There was no correlation between age, sex, clinical staging, and recurrence. In conclusion, the expression of maspin is not related to recurrence of early stage oral tongue cancer. It is inversely correlated with that of mutant-type p53 and of VEGF, suggesting that the maspin gene is a mutant-type p53 target in vivo and may contribute to regulate VEGF expression.
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Affiliation(s)
- Jae Hoon Cho
- Department of Otorhinolaryngology, Head and Neck Surgery, College of Medicine, Kon-Kuk University, Seoul, Republic of Korea
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Iguchi H, Kusuki M, Nakamura A, Kanazawa A, Hachiya K, Yamane H. Outcome of preoperative concurrent chemoradiotherapy and surgery for resectable lingual squamous cell carcinoma greater than 3cm: The possibility of less extensive surgery. Oral Oncol 2006; 42:391-7. [PMID: 16423554 DOI: 10.1016/j.oraloncology.2005.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2005] [Accepted: 09/20/2005] [Indexed: 11/30/2022]
Abstract
We present the outcome of treatment with preoperative concurrent chemoradiotherapy and surgery for resectable lingual squamous cell carcinoma more than 3 cm in its greatest dimension. Twenty patients were enrolled in this study between June 2001 and August 2004. Concurrent chemoradiotherapy included intraarterial pirarubicin (THP) (5 mg/day), intravenous continuous 5-FU, and radiation, usually followed by surgery. Complete response rate was 100%. Notably, 8 of 12 patients who underwent surgery exhibited pathologically complete response, though three patients developed recurrence or distant metastasis. The main adverse effects were mucositis (13/20) and leucopenia (9/20), both of which were acceptable. Although long-term results should be considered, our treatment method appears very useful for lingual squamous cell carcinoma greater than 3 cm, with a remarkably high rate of pathological local control and acceptable adverse events.
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Affiliation(s)
- Hiroyoshi Iguchi
- Department of Otolaryngology and Head and Neck Surgery, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
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