The effect of tumor width and depth on extracapsular lymp node metastases in tongue tumors

Yıl 2010, Cilt: 20 Sayı: 1, 18 - 24, 10.01.2010

Murat Ulusan Murat Enöz Tolgar Lütfi Kumral Yusufhan Süoğlu

Öz

Objectives: In this study, we investigate the relationship between the effects of tumor width and depth with the extracapsular nodal spread ECS in oral tumors. Patients and Methods: In this study we investigate retrospectively data of 107 patients 69 males, 38 females; mean age 45 years; range 25 to 79 years with tongue tumors, who had undergone surgery in our clinic, between 1994 and 2004. Twenty one of them had ECS. The effects of tumor width and depth on various parameters such as nodal metastases, survival, grade and ECS are investigated. Results: It was found that tumor width and depth were the most important factors that affect ECS and logistic regression analysis point out tumor width influence more than tumor depth. Receiver operating characteristic ROC -curve analysis shows us when tumor width exceeds 3.7 cm or tumor depth exceeds 2.4 cm, rate of ECS reaches the maximum sensitivity and specificity. Conclusion: Tumor width and depth has affects on survival and prognosis but also they have significant relation with ECS.

Anahtar Kelimeler

Extracapsular spread, tongue tumor, tumor width/depth

Dil tümörlerinde, tümör genişliğinin ve derinliğinin metastatik lenf nodundaki ekstrakapsüler yayılıma olan etkisi

Öz

Amaç: Bu çalışmada dil kanserinde tümör genişliği ve derinliğinin ekstrakapsüler nodal yayılım EKY ile olan ilişkisi incelendi.Hastalar ve Yöntemler: Bu çalışmada kliniğimizde dil tümörü nedeniyle 1994-2004 yılları arasında ameliyat edilmiş olan 107 olgunun 69 erkek, 38 kadın; ort. yaş 45 yıl; dağılım 25-79 yıl verileri geriye yönelik olarak incelendi. Olguların 21’inde EKY vardı. Tümörün genişliğinin ve derinliğinin nodal yayılım, sağkalım, evre, EKY gibi çeşitli faktörlere olan etkisi araştırıldı.Bulgular: Tümör genişliği ve derinliğinin ekstrakapsüler yayılıma en çok etki eden faktörler olduğu tespit edildi. Bu iki parametrenin lojistik regresyon analiziyle karşılaştırılması sonucu tümörün genişliğinin, derinlikten daha önemli olduğu görüldü. ROC receiver operating characteristic eğrisi incelemesinde tümörün genişliği 3.7 cm’yi, derinliği ise 2.4 cm’yi geçtiğinde EKY açısından maksimum duyarlılık ve özgüllüğe ulaştı.Sonuç: Sonuç olarak, tümör genişliği ve derinliğinin prognoz ve sağkalım üzerine etkileri olduğu gibi; EKY ile de aralarında anlamlı bir ilişki vardır

Anahtar Kelimeler

Ekstrakapsüler yayılım, dil kanseri, tümör genişliği/derinliği

Kaynakça

• Shingaki S, Nomura T, Takada M, Kobayashi T, Suzuki I, Nakajima T. The impact of extranodal spread of lymph node metastases in patients with oral cancer. Int J Oral Maxillofac Surg 1999;28:279-84.
• 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.
• Puri SK, Fan CY, Hanna E. Significance of extracapsu- lar lymph node metastases in patients with head and neck squamous cell carcinoma. Curr Opin Otolaryngol Head Neck Surg 2003;11:119-23.
• Connor SE, Olliff JF. Imaging of malignant cervi- cal lymphadenopathy. Dentomaxillofac Radiol 2000; 29:133-43.
• Broders AC. Squamous epithelioma of the lip: a study of live hundred and thirty-seven cases. J Am Med Assoc 1920;74:656-64.
• Ambrosch P, Kron M, Fischer G, Brinck U. Micrometastases in carcinoma of the upper aerodi- gestive tract: detection, risk of metastasizing, and prognostic value of depth of invasion. Head Neck 1995;17:473-9.
• Woolgar JA, Scott J. Prediction of cervical lymph node metastasis in squamous cell carcinoma of the tongue/ floor of mouth. Head Neck 1995;17:463-72.
• Keski-Säntti H, Atula T, Tikka J, Hollmén J, Mäkitie AA, Leivo I. Predictive value of histopathologic param- eters in early squamous cell carcinoma of oral tongue. Oral Oncol 2007;43:1007-13.
• Johnson JT, Barnes EL, Myers EN, Schramm VL Jr, Borochovitz D, Sigler BA. The extracapsular spread of tumors in cervical node metastasis. Arch Otolaryngol 1981;107:725-9.
• Woolgar JA, Rogers S, West CR, Errington RD, Brown JS, Vaughan ED. Survival and patterns of recurrence in 200 oral cancer patients treated by radical surgery and neck dissection. Oral Oncol 1999;35:257-65.
• Woolgar JA, Rogers SN, Lowe D, Brown JS, Vaughan ED. Cervical lymph node metastasis in oral cancer: the importance of even microscopic extracapsular spread. Oral Oncol 2003;39:130-7.
• DiTroia JF. Nodal metastases and prognosis in carci- noma of the oral cavity. Otolaryngol Clin North Am 1972;5:333-42.
• Pentenero M, Gandolfo S, Carrozzo M. Importance of tumor thickness and depth of invasion in nodal involvement and prognosis of oral squamous cell carcinoma: a review of the literature. Head Neck 2005; 27:1080-91.
• Kim SH, Cho NH, Kim K, Lee JS, Koo BS, Kim JH, et al. Correlations of oral tongue cancer invasion with matrix metalloproteinases (MMPs) and vascular endothelial growth factor (VEGF) expression. J Surg Oncol 2006;93:330-7.
• Borges AM, Shrikhande SS, Ganesh B. Surgical pathol- ogy of squamous carcinoma of the oral cavity: its impact on management. Semin Surg Oncol 1989;5:310-7.
• Fakih AR, Rao RS, Borges AM, Patel AR. Elective ver- sus therapeutic neck dissection in early carcinoma of the oral tongue. Am J Surg 1989;158:309-13.
• 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.
• Suzuki M, Suzuki T, Asai M, Ichimura K, Nibu K, Sugasawa M, et al. Clinicopathological factors related to cervical lymph node metastasis in a patient with carcinoma of the oral floor. Acta Otolaryngol Suppl 2007;559:129-35.
• Jung J, Cho NH, Kim J, Choi EC, Lee SY, Byeon HK, et al. Significant invasion depth of early oral tongue cancer originated from the lateral border to pre- dict regional metastases and prognosis. Int J Oral Maxillofac Surg 2009;38:653-60.
• Lam P, Au-Yeung KM, Cheng PW, Wei WI, Yuen AP, Trendell-Smith N, et al. Correlating MRI and histo- logic tumor thickness in the assessment of oral tongue cancer. AJR Am J Roentgenol 2004;182:803-8.
• Kurokawa H, Yamashita Y, Takeda S, Zhang M, Fukuyama H, Takahashi T. Risk factors for late cervi- cal lymph node metastases in patients with stage I or II carcinoma of the tongue. Head Neck 2002;24:731-6.