Primary and recurrent regional metastases for lateralized oral cavity squamous cell carcinoma

Elsevier

Available online 30 July 2022, 101804

Surgical OncologyHighlights•

Lateralized OCSCC with LVI or T3-4 were more likely to have regional metastases.

Tumors of the hard palate, upper alveolus, or with LVI more often regionally recur.

Metastases are occasional to levels IV-V but rare to IA, IIB and contralateral neck.

Additional treatment of levels IV and V may be warranted for lateralized OCSCC.

Elective neck dissection is suggested for upper alveolar/palate SCC with DOI ≥4 mm.

AbstractObjectives

Map regional lymph node metastases for lateralized oral cavity squamous cell carcinoma (OCSCC) and evaluate factors associated with regional metastases and recurrence.

Materials and methods

Retrospective 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.

Results

Regional 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.

Conclusions

For 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.

Keywords

Oral cavity

Oral cancer

Squamous cell carcinoma

Regional

Metastases

Lateralized

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