Primary and recurrent regional metastases for lateralized oral cavity squamous cell carcinoma |
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| Affiliation: | 1. Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, TX, United States;2. Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, United States;3. Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States;4. Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States;5. Division of Child Neurology, Cohen Children''s Medical Center, Northwell Health, New York, NY, United States;6. Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, United States;1. Department of Chemotherapy, Kazakh Institute of Oncology and Radiology, Almaty, Republic of Kazakhstan;2. Department of Oncology with the Course of Hematology, Kazakh Medical University of Continuing Education, Almaty, Republic of Kazakhstan;3. Department of Administration, Kazakh Institute of Oncology and Radiology, Almaty, Republic of Kazakhstan;4. Consultative and Diagnostic Center, Kazakh Institute of Oncology and Radiology, Almaty, Republic of Kazakhstan;5. Operating Theatre, Kazakh Institute of Oncology and Radiology, Almaty, Republic of Kazakhstan;6. Department of Oncology, S.D. Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan;1. Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126, Pisa, Italy;2. Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Risorgimento 36, 56126, Pisa, Italy;3. Department of Diagnostic and Interventional Radiology, and Nuclear Medicine, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy;4. General Surgery, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy;5. Hepatology Unit, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy;6. Regional Center of Nuclear Medicine, University Hospital of Pisa, Via Roma 67, 56126, Pisa, Italy;1. Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel;2. The Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel;1. Department of Cardiothoracic Surgery, Heart Center, University Hospital Cologne, Kerpener Strasse 62 50937, Cologne, Germany;2. Clinic for Pneumology and Allergology, Hospital Bethanien, Aufderhöher Strasse, 169 42699, Solingen, Germany |
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| Abstract: | ObjectivesMap regional lymph node metastases for lateralized oral cavity squamous cell carcinoma (OCSCC) and evaluate factors associated with regional metastases and recurrence.Materials and methodsRetrospective cohort study of 715 patients with lateralized OCSCC surgically treated in 1997–2011. Analysis was performed using log-rank, Kaplan-Meier, and multivariable logistic and Cox regression.ResultsRegional metastases were identified in ipsilateral levels IIA (24%), IB (18%), III (13%), V (9%), IV (7%), IA (2%) and IIB (1%) and the contralateral neck (3%). Lymphovascular invasion (LVI) (Hazard Ratio [HR] 2.2, 95% Confidence Interval [CI] 1.2–3.9) and T category (T3 vs. T1: HR 4.1, 95% CI 1.9–9.3; T4 vs. T1: HR 2.3, 95% CI 1.2–4.3) were associated with regional metastases. Most (71%) isolated regional metastatic recurrences were in undissected levels of the neck, including 58% in levels IV and V. Tumors of the hard palate (HR 4.3, 95% CI 1.2–16.1), upper alveolus (HR 3.2, 95% CI 1.0–4.7) or with LVI (HR 2.0, 95% CI 1.0–3.9) were associated with isolated regional recurrence. For upper alveolar/hard palate tumors, depth of invasion (DOI) ≥4 mm (P = .003) and LVI (P = .04) were associated with regional metastases.ConclusionsFor lateralized OCSCC, elective neck dissection of level IIB or the contralateral neck may rarely be needed, but additional surgical or radiation treatment of levels IV and V may be considered based on patient risk factors, including T category 3–4 or LVI. For upper alveolar/hard palate tumors, DOI ≥4 mm is an appropriate threshold for elective neck dissection. |
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| Keywords: | Oral cavity Oral cancer Squamous cell carcinoma Regional Metastases Lateralized |
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