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Frequency of Cervical Nodal Metastasis in Early-Stage Squamous Cell Carcinoma of the Tongue.

ABSTRACT: Introduction ?Oral cavity carcinoma is an aggressive tumor, with the tongue being one of the most common subsites of involvement. Surgery is a gold standard method of dealing with advanced-stage tumors. However, for early-stage carcinomas of the tongue, the management remains controversial. Several studies have indicated that early-stage cancers have a high chance of occult cervical node metastasis, which, if left untreated, can greatly affect the prognosis. Certain parameters can help identify patients with occult cervical node metastases, and can avoid unnecessary neck dissection in node negative patients. Tumor thickness is one such objective parameter. Objective ?To estimate the frequency of cervical lymph node metastasis in patients with early-stage, node-negative (N 0 ) squamous cell carcinoma of the tongue. Methods ?In-patient hospital data was reviewed from January 2013 until March 2014, and 78 patients who underwent primary resection of the tumor and neck dissection for biopsy-proven, early stage squamous cell carcinoma of the tongue were included. Data such as tumor thickness, tumor differentiation and presence of occult nodal metastasis in the surgical specimen were gathered from the histopathology reports. The frequency of subclinical cervical lymph node metastasis in patients with early-stage squamous cell carcinoma of the tongue was estimated. Results ?A total of 69% of the patients with tumor thicknesses?>?5?mm had tumor metastases in the neck nodes, while 100% of the patients with tumor thicknesses??5?mm is significantly associated with subclinical metastasis, and prophylactic neck dissection is warranted in such cases.

SUBMITTER: Ahmed SQ

PROVIDER: S-EPMC5882373 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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Frequency of Cervical Nodal Metastasis in Early-Stage Squamous Cell Carcinoma of the Tongue.

Ahmed Sadaf Qadeer SQ Junaid Montasir M Awan Sohail S Kazi Maliha M Khan Hareem Usman HU Halim Sohail S

International archives of otorhinolaryngology 20170606 2

<b>Introduction</b> Oral cavity carcinoma is an aggressive tumor, with the tongue being one of the most common subsites of involvement. Surgery is a gold standard method of dealing with advanced-stage tumors. However, for early-stage carcinomas of the tongue, the management remains controversial. Several studies have indicated that early-stage cancers have a high chance of occult cervical node metastasis, which, if left untreated, can greatly affect the prognosis. Certain parameters can help id ...[more]

PMID: 29619101

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Project description:ObjectiveMET positivity is independently associated with survival in oral squamous cell carcinoma (OSCC). Since MET is a known orchestrator of invasive tumor growth, we investigated its association with LNM in early oral tongue squamous cell carcinoma (OTSCC). As it is recommended by the NCCN to use tumor depth of invasion (DOI) in making decisions on elective neck dissection (END), the results obtained for MET positivity were aligned with those for DOI > 4 mm. The cutoff value used in our institution.MethodsTumor samples from patients who underwent primary tumor resection and neck dissection between 1995 and 2013, were collected from the archives of the Leiden and Erasmus University Medical Center. Immunohistochemistry with D1C2 was performed to identify MET negative (< 10% uniform positivity) and MET positive (≥ 10% uniform positivity) cancers. ROC curve analysis and the Chi-squared test were used to investigate the association of MET positivity with LNM (pN+ and occult). Binary logistic regression was used to investigate the association of MET positivity with LNM.ResultsForty-five (44.1%) of the 102 cancers were MET positive. Ninety were cN0 of which 20 were pN+ (occult metastasis). The remaining 12 cancers were cN+, of which 10 were proven pN+ and 2 were pN0. MET positivity was associated with LNM with a positive predictive value (PPV) of 44.4% and a negative predictive value (NPV) of 82.5% for pN+. For the occult group, the PPV was 36.8% and the NPV was 88.5%. Regression analysis showed that MET positivity is associated with pN+ and occult LNM (p-value < 0.05).ConclusionMET positivity is significantly associated with LNM in early OTSCC, outperforming DOI. The added value of MET positivity could be in the preoperative setting when END is being considered during the initial surgery. For cases with DOI ≤ 4 mm, MET positivity could aid in the clinical decision whether regular follow-up, watchful waiting, or END is more appropriate. Realizing that these preliminary results need to be independently validated in a larger patient cohort, we believe that MET positivity could be of added value in the decision making on END in early OTSCC.

Project description:BackgroundLack of adequate objectivity and universality, available models are still difficult to be applied to clinical practice in predicting occult cervical metastasis of early oral squamous cell carcinoma (OSCC). Taking abnormal metabolic state into consideration, the current model is helpful to distinguish those patients with or without occult cervical metastasis.MethodsThis study retrospectively analyzed 330 OSCC patients initially diagnosed cT1-2N0M0 stage and received neck dissection from January 2020 to July 2022. The occult cervical metastasis was identified by pathological examination.. After screening independent risk factors using logistic regression, patients were divided into training and validation cohorts at the ratio of 2:1 randomly, and a novel diagnostic model was constructed. Performances of this model were evaluated by the area under the curve (AUC), calibrating curve, decision curve analysis (DCA) and clinical impact curve (CIC).ResultsOf the 330 included patients {age mean [standard deviation (SD)], 61.24 (12.99) years; 202 (61.2%) males}, 49 (14.8%) had occult nodal metastasis. Five variables, including body mass index (BMI) [high odds ratio (OR): 1.132; 95% confidence interval (CI): 1.019-1.258, P=0.021], primary tumor site (tongue & floor of mouth (TF) OR: 3.756; 95% CI: 1.295-10.898, P=0.015), depth of invasion (DOI) (5-10 mm OR: 2.973; 95% CI: 1.266-6.981; P=0.012), pathological differentiation (Poor differentiation OR: 2.65; 95% CI: 1.341-5.239; P=0.005), and diabetes (OR: 3.123; 95% CI: 1.23-7.929; P=0.017) were screened to establish the predictive model. In training cohort (n=220), this model achieved an AUC of 0.814 and had a sensitivity of 78.1% and specificity of 70.2%. Calibration plots showed favorable consistency between the prediction of the model and actual observations (Hosmer-Lemeshow value >0.05). Decision curve analysis (DCA) and clinical impact curve (CIC) showed the model was clinically useful and had better discriminative ability under the threshold probability of 0.5. Above evaluations were verified in the validation cohort (n=110). Compared to previous reported models, the concordance index (C-index), net reclassification index (NRI), and integrated discrimination improvement (IDI) values were superior in both training and validation cohorts (P<0.05).ConclusionsThis constructed model might have reference value for clinicians in making neck management decisions of early OSCC patients.

Dataset Information

Frequency of Cervical Nodal Metastasis in Early-Stage Squamous Cell Carcinoma of the Tongue.

Publications

Frequency of Cervical Nodal Metastasis in Early-Stage Squamous Cell Carcinoma of the Tongue.

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