Depth of invasion, size and number of metastatic nodes predicts extracapsular spread in early oral cancers with occult metastases

Mair, Manish; Shetty, Rathan; Nair, Deepa; Mathur, Yash; Nair, Sudhir; Deshmukh, Anuja; Thiagarajan, Shivakumar; Pantvaidya, Gouri; Lashkar, Sarbani Ghosh; Prabhash, Kumar; Chaukar, Devendra; Pai, Prathamesh; Cruz, Anil D’; Chaturvedi, Pankaj

doi:10.1016/j.oraloncology.2018.04.015

Cited by 28 publications

(21 citation statements)

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“…In another study by Jung et al [30], the authors recommended a cut-off value of 10.5 mm in contrast-enhanced T1-weighted images and showed a significant correlation with nodal metastasis, but the authors failed to give the information about the sensitivity, and the variation from ours could be explained by the different calculation method of the cut-off value. The potential mechanism for our interesting finding was presented as follows: MRI-determined DOI could indirectly reflect the pathologic DOI, mean difference between MRI-determined DOI and pathologic DOI was 2.7mm in current study, therefore, a MRI-determined DOI cut-off value of 7.5mm would be indicating a pathologic DOI cut-off value of 5.0mm, extensive literature had reported the neck lymph node metastasis risk increased apparently if there was pathologic DOI >5.0mm [10,11,28,29].…”

Section: Discussionmentioning

confidence: 47%

“…Depth of invasion (DOI) is now added in the newest edition of AJCC tumor-node-metastasis staging system [9], and abundant literature has showed the significant relationship between DOI and neck lymph node metastasis [10][11][12], however, data regarding pathologic DOI usually can not be obtained by frozen section or incisional biopsy, it might has limited role on benefiting decision making of neck treatment preoperatively. MRI has been widely used to evaluate the soft tissue disease, and current evidence has reported the reliability of MRI in measuring the DOI [13,14] as well as the prognostic value of MRI-determined tumor thickness in tongue SCC [15,16], the MRI-determined DOI is significantly different from the MRI-determined tumor thickness, but whether MRI-determined DOI has the same effect with the MRI-determined tumor thickness and whether it could be used as an indicator for END for cT1N0 tongue SCC remain unknown, therefore, the main goal of current study was to clarify these questions.…”

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confidence: 99%

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Depth of invasion determined by MRI in cT1N0 tongue: is it an indicator for elective neck dissection?

Yuan

Kang

et al. 2019

Preprint

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Abstracts Background Depth of invasion (DOI) could be calculated by MRI preoperatively, whether MRI-determined DOI could predict the prognosis and whether it could be used as an indicator for neck dissection for cT1N0 tongue squamous cell carcinoma (SCC) remain unknown, the main goal of the current study aimed to answer the questions. Methods Patients with surgically treated cT1N0 tongue SCC were retrospectively enrolled, MRI-determined DOI was measured based on T1-weigthed layers by a 1.5T scan. A multivariate logistic regression analysis model was used to determine the independent predictors for occult neck lymph node metastasis. The main study endpoints were locoregional control survival (LRC) and disease specific survival (DSS), the Cox model was used to determine the independent prognostic factors for the LRC and DSS. Results Occult neck lymph node metastasis was noted in 26 (17.2%) patients, ROC curve indicated the optimal cutoff value of MRI-determined DOI was 7.5mm for predicting neck lymph node metastasis with sensitivity of 86.9%. The factors of lymphovascular invasion, MRI-determined DOI, pathologic DOI, and pathologic tumor grade were significantly associated with the presence of neck lymph node metastasis in univariate analysis, further logistic regression analysis confirmed the independence of lymphovascular invasion, MRI-determined DOI, and pathologic DOI in predicting the neck lymph node metastasis. The 5-year LRC and DSS rates were 84% and 90%, respectively. Cox model analysis suggested the MRI-determined DOI was an independent prognostic factor for both the LRC and DSS. Conclusions Elective neck dissection is suggested if MRI-determined DOI is greater than 7.5mm in cT1N0 tongue SCC, and MRI-determined DOI ≥7.5mm indicates more risk for disease recurrence and cancer caused death.

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Section: Discussionmentioning

confidence: 47%

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confidence: 99%

Depth of invasion determined by MRI in cT1N0 tongue: is it an indicator for elective neck dissection?

Yuan

Kang

et al. 2019

Preprint

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“…In OSCC, the nodal staging recommendations have upstaged extranodal extension (ENE) of metastatic nodes, which has been reported as a high-risk adverse feature associated with worse survival [5]. The presence of ENE is an independent adverse prognostic factor in OSCC [6,7], and it significantly decreases survival [8,9] as well as locoregional and distant control [10,11].…”

Section: Introductionmentioning

confidence: 99%

Nuclear Magnetic Resonance Metabolomics Biomarkers for Identifying High Risk Patients with Extranodal Extension in Oral Squamous Cell Carcinoma

Tsai

Lin

Kang

et al. 2020

JCM

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Extranodal extension (ENE) is an independent adverse prognostic factor in oral squamous cell carcinoma (OSCC), and is difficult to identify preoperatively. We aimed to discover biomarkers for high risk patients with ENE. Tandem tissue, plasma, and urine samples of 110 patients with OSCC were investigated through 600-MHz nuclear magnetic resonance (NMR) metabolomics analysis. We found that the levels of creatine, creatine phosphate, glycine, and tyramine in plasma significantly decreased in stage IV ENE positive OSCC compared with stage IV ENE negative OSCC. To understand the underlying mechanism behind the alteration of plasma metabolites, our tissue analysis revealed that the carnitine level significantly increased in tumors but significantly decreased in the adjacent normal tissue in advanced stage OSCC, in addition to decreased levels of alanine and pyruvate in tumor tissues. The global metabolomics analysis on tumor tissues also showed that stage IV tumors with an ENE positive status demonstrated higher levels of aspartate, butyrate, carnitine, glutamate, glutathione, glycine, glycolate, guanosine, and sucrose but lower levels of alanine, choline, glucose, isoleucine, lactate, leucine, myo-inositol, O-acetylcholine, oxypurinol, phenylalanine, pyruvate, succinate, tyrosine, valine, and xanthine than tumors with an ENE negative status. We concluded that metabolomics alterations in tumor tissues correspond to an increase in the tumor stage and are detectable in plasma samples. Metabolomic alterations of OSCC can serve as potential diagnostic markers and predictors of ENE in patients with stage IV OSCC.

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“…Management of patients with clinically node-negative (cN0) early-stage oral cancer remains controversial [1][2][3][4][5][6]. Particularly, early oral tongue cancer has a strong tendency to metastasize to regional lymph nodes subclinically, with metastasis rates between 23% and 40% [7][8][9][10]. Among various factors in uencing prognosis in oral cancer patients, pathologic depth of invasion (pDOI) is currently the most accurate predictor of occult metastasis and should be used to guide decision-making according to the newly updated American Joint Committee on Cancer (AJCC), 8th Edition.…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of Multiparametric Mri-based Nomogram for Predicting Occult Metastasis Risk in Early Tongue Squamous Cell Carcinoma

Saenthaveesuk

Yang

Zeng

et al. 2020

Preprint

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Background: Nomograms are currently used in predicting individualized outcomes in clinical oncology of several cancers. However, nomograms for evaluating occult nodal metastasis of patients with squamous cell carcinoma of lateral tongue (SCCLT) have not been widely investigated for their functionality. This retrospective cohort study was designed to address this question.Methods: This study was divided into primary and validation cohorts. The primary cohort comprised 120 patients diagnosed between 2012 and 2017, whereas the validation cohort included 41 patients diagnosed thereafter. The diagnostic value of multiparametric MRI, including radiologic tumor thickness threshold (rTTT) in three-dimensions, paralingual distance, and sublingual distance were investigated. A nomogram was developed based on stepwise logistic regression of potential predictors associated with nodal metastasis in the primary cohort and then tested for predictive accuracy in the validation cohort using area under the curve (AUC) and goodness-of-fit tests.Results: Multivariate analysis, tumor size (odd ratio [OR] 15.175, 95% confidence interval [CI] 1.436-160.329, P = 0.024), rTTT (OR 11.528, 95% CI 2.483-53.530, P = 0.002), paralingual distance (OR 11.976, 95% CI 1.981-72.413, P = 0.005), and tumor location (OR 6.311, 95% CI 1.514-26.304, P = 0.011) were included in the nomogram to predict the likelihood of having cervical metastasis. A nomogram cutoff value of 210 points (sensitivity 93.8%, specificity 87.5%) was significantly different to classify the patients metastasis risk group (P< 0.001). Nomogram showed predictive accuracy with AUC 0.881 (95% CI 0.779–0.983, P< 0.001) and good calibration after the validation.Conclusions: A preoperative nomogram incorporating multiparametric MRI demonstrated good prediction and performed adequately in our study. Three-dimensional assessment of occult metastasis risk value obtained from this nomogram can assist in preoperative decision making whether to manage with neck surgery for individual patients with early-stage SCCLT. The probability of nodal metastasis tended to be greater than 20% in patients with high metastasis risk or nomogram total score > 210 points.

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Depth of invasion, size and number of metastatic nodes predicts extracapsular spread in early oral cancers with occult metastases

Cited by 28 publications

References 21 publications

Depth of invasion determined by MRI in cT1N0 tongue: is it an indicator for elective neck dissection?

Depth of invasion determined by MRI in cT1N0 tongue: is it an indicator for elective neck dissection?

Nuclear Magnetic Resonance Metabolomics Biomarkers for Identifying High Risk Patients with Extranodal Extension in Oral Squamous Cell Carcinoma

Development and Validation of Multiparametric Mri-based Nomogram for Predicting Occult Metastasis Risk in Early Tongue Squamous Cell Carcinoma

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