Facial lymph node involvement as a prognostic factor for patient survival in oral cavity squamous cell carcinoma

Abstract

To investigate the incidence of metastasis to facial lymph nodes (FLNs) and to determine its impact on the prognosis and survival of patients at onset of oral cavity squamous cell carcinoma (OSCC). A retrospective review of 641 patients with OSCC treated with curative surgery (CS) alone or CS + postoperative radiotherapy (PORT) was performed. Based on FLN status, an analysis of clinicopathologic parameters, prognosis, and survival was conducted. By classifying patients according to FLN status, a reasonable treatment modality was identified in the low-risk group, which was defined as those who had N0-1 disease, negative margin, and no extracapsular nodal spread (ENS). FLN involvement was identified in 103 patients (16 %), which showed statistically significant associations with several established risk factors and negatively affected local controls (P < 0.001), neck controls (P < 0.001), and disease-specific survival (P < 0.001). Compared to CS alone, CS + PORT increased the 5-year neck control rate (76.8 vs. 30.7 %, P = 0.006) and disease-specific survival rate (67.8 vs. 30.7 %, P = 0.037) of the OSCC patients with FLN metastasis in the low-risk group. Metastasis to FLNs is strongly associated with poor disease control and lower survival rate of OSCC patients. PORT minimized the residual risk of involved FLN in the low-risk group.

Clinico-pathological prognosticators in oral squamous cell carcinoma

“…Of 641 OSCC patients, 103 presented with metastasis to facial lymph nodes and were strongly associated with poor disease control and lower survival rates. 102 Studies have also shown that the number, size as well as occult node metastasis have a significant impact on the survival rates. [103][104][105] Lymph node ratio.…”

Regional metastasis to anatomies beyond traditional neck dissection boundaries: a multi-institutional analysis focused on unconventional metastases in oral cancer patients

“…Such non-categorization in standard neck dissection procedures was claimed to be based on a low incidence of metastasis (9%) and possible coverage by prophylactic radiotherapy [ 6 , 21 ]. As opposed to other studies, buccinator lymphatic metastases in our study were mostly encountered in patients for staged (secondary) neck dissections after previous resection of local malignancies [ 6 , 22 ]. Thus, more concerns should be raised for suspected UMLNs in the buccal (supra-mandibular) intermediate region before these staged neck dissections, especially in SCCOC patients with upper gingival or palatal origins.…”

Metastasis of lower gingival squamous cell carcinoma to buccinator lymph node: case report and review of the literature

“…Metastasis of oral squamous cell carcinoma (OSCC) to FN has been reported to indicate advanced disease [1, 13] and to be a risk factor for local recurrence and poor prognosis [1, 2]. A study comparing outcomes in patients with OSCC found that the 5-year local control rates were 55.7% in patients with and 72% in patients without metastasis to FN ( P < 0.001) and that the 5-year disease-specific survival rates were 43% and 57.4%, respectively ( P < 0.001) [2].…”

“…Metastasis of oral squamous cell carcinoma (OSCC) to FN has been reported to indicate advanced disease [1, 13] and to be a risk factor for local recurrence and poor prognosis [1, 2]. A study comparing outcomes in patients with OSCC found that the 5-year local control rates were 55.7% in patients with and 72% in patients without metastasis to FN ( P < 0.001) and that the 5-year disease-specific survival rates were 43% and 57.4%, respectively ( P < 0.001) [2]. Moreover, analysis of patients with metastases to FN who had N0–1 disease, negative surgical margins, and no extracapsular spread found that 5-year disease-specific survival rates were higher in those who received surgery followed by postoperative radiotherapy than those who received surgery alone (67.8% vs. 30.7%, P = 0.037) [2].…”

“…Metastasis to the lymph nodes is the most prognostic factor in patients with oral cancer. Primary cancers in the oral region frequently metastasize to level I–III nodes, whereas metastasis of oral cancer to facial lymph nodes (FN) is rare [1, 2]. FN have been subcategorized as malar, infraorbital, buccinator, and mandibular lymph nodes [3].…”