Correlation of tumor thickness with occult neck nodes in buccal and oral tongue early squamous-cell carcinomas

Year 2017, Volume: 27 Issue: 3, 128 - 134, 25.07.2017

Shakeel Uz Zaman Shakil Aqil Mohammad Ahsan Sulaiman

Abstract

Objectives: The aim of this study is to investigate the frequency of occult neck nodes and their relationship with tumor thickness in early squamous-cell carcinomas SCCs of buccal and oral tongue. Patients and Methods: We retrospectively reviewed the medical records and pathology reports of 77 previously untreated patients of SCCs of the oral cavity 44 buccal & 33 oral tongue who underwent tumor excision surgery between July 2012 and June 2015. Patients with early lesions T1 and T2 with clinically negative neck were included and their clinicopathological features, number of occult neck nodes and their correlation with tumor thickness were analyzed. Results: Occult neck nodes were found in 27 patients 46% buccal and 27% oral tongue . In both groups, chances of occult neck disease increased, when the thickness of tumor reached 5 mm or above. Similarly 5 mm was the minimum tumor thickness in both groups in which occult nodes were found up to level III of neck in contrast to level I and II in ≤4 mm lesions. Conclusion: Tumor thickness of ≥5 mm is significantly associated with occult neck nodes in both early buccal and oral tongue SCCs. Elective neck dissection should be done in such cases.

Keywords

Buccal, occult neck node, oral tongue, squamous-cell carcinoma, tumor thickness

Erken evre bukkal ve oral dil skuamöz hücreli karsinomlarda tümör kalınlığının okült boyun nodları ile ilişkisi

Abstract

Amaç: Bu çalışmada erken evre bukkal ve oral dilin skuamöz hücreli karsinomlarında SHK okült boyun nodlarının görülme sıklığı ve tümör kalınlığı ile olan ilişkisi araştırıldı.Hastalar ve Yöntemler: Temmuz 2012 - Haziran 2015 tarihleri arasında oral kavitede SHK 44 bukkal ve 33 oral dil nedeniyle daha önce tedavi edilmemiş 77 hastanın tıbbi kayıtları ve patoloji raporları retrospektif olarak incelendi. Klinik olarak boyun negatif, erken evre lezyonlu hastalar T1 ve T2 çalışmaya alındı ve hastaların klinik-patolojik özellikleri, okült boyun nodu sayısı ve tümör kalınlığı olan ilişkisi incelendi.Bulgular: Okült boyun nodları 27 hastada %46 bukkal ve %27 oral dil bulundu. Her iki grupta da, tümör kalınlığı 5 mm ve üzerine ulaştığında okült boyun hastalığı olasılığı artmıştı. Benzer şekilde, ≤4 mm lezyonlarda seviye I ve II’ye kıyasla, okült boyun nodlarının seviye III’e ulaşması halinde, 5 mm her iki grupta da minimum tümör kalınlığı idi.Sonuç: ≥5 mm tümör kalınlığı, erken evre bukkal ve oral dil SHK’de okült boyun nodları ile anlamlı düzeyde ilişkilidir. Bu hastalarda elektif boyun diseksiyonu yapılmalıdır

Keywords

Bukkal, okült boyun nodu, oral dil, skuamöz hücreli karsinom, tümör kalınlığı

References

• 1. Ross GL, Soutar DS, MacDonald DG, Shoaib T, Camilleri IG, Robertson AG. Improved staging of cervical metastases in clinically node-negative patients with head and neck squamous cell carcinoma. Ann Surg Oncol 2004;11:213-8.
• 2. Huang SH, Hwang D, Lockwood G, Goldstein DP, O’Sullivan B. Predictive value of tumor thickness for cervical lymph-node involvement in squamous cell carcinoma of the oral cavity: a meta-analysis of reported studies. Cancer 2009;115:1489-97.
• 3. Kligerman J, Lima RA, Soares JR, Prado L, Dias FL, Freitas EQ, et al. Supraomohyoid neck dissection in the treatment of T1/T2 squamous cell carcinoma of oral cavity. Am J Surg 1994;168:391-4.
• 4. O-charoenrat P, Pillai G, Patel S, Fisher C, Archer D, Eccles S, et al. Tumour thickness predicts cervical nodal metastases and survival in early oral tongue cancer. Oral Oncol 2003;39:386-90.
• 5. Mishra RC, Parida G, Mishra TK, Mohanty S. Tumour thickness and relationship to locoregional failure in cancer of the buccal mucosa. Eur J Surg Oncol 1999;25:186-9.
• 6. O’Brien CJ, Lauer CS, Fredricks S, Clifford AR, McNeil EB, Bagia JS, et al. Tumor thickness influences prognosis of T1 and T2 oral cavity cancer--but what thickness? Head Neck 2003;25:937-45.
• 7. Hiratsuka H, Miyakawa A, Nakamori K, Kido Y, Sunakawa H, Kohama G. Multivariate analysis of occult lymph node metastasis as a prognostic indicator for patients with squamous cell carcinoma of the oral cavity. Cancer 1997;80:351-6.
• 8. Tai SK, Li WY, Yang MH, Chu PY, Wang YF, Chang PM. Perineural invasion as a major determinant for the aggressiveness associated with increased tumor thickness in t1-2 oral tongue and buccal squamous cell carcinoma. Ann Surg Oncol 2013;20:3568-74.
• 9. Urist MM, O’Brien CJ, Soong SJ, Visscher DW, Maddox WA. Squamous cell carcinoma of the buccal mucosa: analysis of prognostic factors. Am J Surg 1987;154:411-4.
• 10. Lim SC, Zhang S, Ishii G, Endoh Y, Kodama K, Miyamoto S, et al. Predictive markers for late cervical metastasis in stage I and II invasive squamous cell carcinoma of the oral tongue. Clin Cancer Res 2004;10:166-72.
• 11. Kurokawa H, Yamashita Y, Takeda S, Zhang M, Fukuyama H, Takahashi T. Risk factors for late cervical lymph node metastases in patients with stage I or II carcinoma of the tongue. Head Neck 2002;24:731-6.
• 12. Sheahan P, O’Keane C, Sheahan JN, O’Dwyer TP. Effect of tumour thickness and other factors on the risk of regional disease and treatment of the N0 neck in early oral squamous carcinoma. Clin Otolaryngol Allied Sci 2003;28:461-71.
• 13. Kane SV, Gupta M, Kakade AC, D’ Cruz A. Depth of invasion is the most significant histological predictor of subclinical cervical lymph node metastasis in early squamous carcinomas of the oral cavity. Eur J Surg Oncol 2006;32:795-803.
• 14. Po Wing Yuen A, Lam KY, Lam LK, Ho CM, Wong A, Chow TL, et al. Prognostic factors of clinically stage I and II oral tongue carcinoma-A comparative study of stage, thickness, shape, growth pattern, invasive front malignancy grading, Martinez-Gimeno score, and pathologic features. Head Neck 2002;24:513-20.
• 15. Kumar T, Patel MD. Pattern of lymphatic metastasis in relation to the depth of tumor in oral tongue cancers: a clinico pathological correlation. Indian J Otolaryngol Head Neck Surg 2013;65:59-63.