Importance of lymph node ratio for locoregional recurrence of squamous cell carcinoma of the buccal mucosa

Safi, Ali-Farid; Grandoch, Andrea; Nickenig, Hans-Joachim; Zöller, Joachim E.; Kreppel, Matthias

doi:10.1002/hed.24922

Cited by 22 publications

(9 citation statements)

References 17 publications

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“…Additionally, a well‐defined cutoff for LNR has yet to be well established in the setting of OPSCC when stratified for HPV status. Many studies evaluating LNR use cutoffs ranging from 0.06 to 0.10 as these cutoff values have previously been established in other head and neck cancers 24,28 …”

Section: Introductionmentioning

confidence: 99%

Evaluation of lymph node ratio and lymph node yield as prognosticators of locoregional recurrence in p16‐associated oropharyngeal squamous cell carcinoma

et al. 2020

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Background The prognostic value of lymph node yield (LNY) and lymph node ratio (LNR), or the ratio of number of metastatic LNs to total number dissected, has not been well established in p16‐associated oropharyngeal squamous cell carcinoma (OPSCC). Methods This retrospective cohort study evaluated locoregional disease‐free survival (LRDFS) in 82 patients with p16+ OPSCC who underwent neck dissection at a single institution from 2009 to 2017. LNR and LNY cutoffs were estimated using time‐dependent receiver operator characteristic (ROC) curves. Prognostic significance of these cutoffs was compared with Eighth Edition AJCC Nodal Staging. Results An increased LNR ≥ 0.129 was associated with worse 2‐year LRDFS (66.9% vs 96.8%, P = .005). LNY was not significantly associated with LRDFS (P = .304). An LNR‐based risk model was a better prognosticator than Eighth Edition AJCC Nodal Staging (Harrell's C, 0.9065 vs 0.7668). Conclusions LNR has good prognostic utility in predicting LRDFS in p16+ OPSCC, but further evaluation of this measure is warranted.

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Section: Introductionmentioning

confidence: 99%

Evaluation of lymph node ratio and lymph node yield as prognosticators of locoregional recurrence in p16‐associated oropharyngeal squamous cell carcinoma

et al. 2020

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“…Lymph nodes were analyzed for nodal stage, extracapsular extension, and lymph node ratio (defined as the ratio between number of pathological cervical lymph nodes and the total number of resected cervical lymph nodes). [5] The site of recurrence was noted along with the duration of recurrence from the date of surgery. [3] Local recurrence was defined as the lesion at the site of or adjacent to the primary tumor which was completely treated.…”

Section: Methodsmentioning

confidence: 99%

Factors Influencing Locoregional Recurrence and Disease-Free Survival in Buccal Mucosal Squamous Cell Carcinoma

Riju

George

2019

Indian J Surg

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Oral cancers are the most common malignancy affecting Indian population with buccal mucosa being the frequent subsite. This study is to evaluate the histopathological factors influencing locoregional recurrence (LRR) and disease-free survival (DFS) in buccal mucosal squamous cell carcinoma (BSCC). One hundred and twenty patients treated surgically for BSCC with a curative intend between January 2014 and December 2015 were retrospectively analyzed. Histopathological factors like tumor stage, grade of differentiation, tumor front, skin involvement, bone involvement, depth of invasion, perineural invasion, lymphovascular emboli, primary resection margin in frozen section, nodal stage, extracapsular extension, and lymph node ratio were analyzed and compared for LRR and DFS. With a median follow-up of 41 months, LRR occurred in 34 patients (28.3%) and a 2-year DFS was 75.8%. Multivariate analysis identified that the factors that independently influenced the LRR were pathological nodal stage (p < 0.0001) and primary resection margin in frozen section (p < 0.0001). A single neck node involvement increases risk by 6.8 times for LRR compared to no nodal involvement (95% CI 2.897-15.888, p < 0.0001). Frozen section studies on primary tumor excision margin showed that close margin had 2.3 times chance of LRR (95% CI 1.020-5.035, p < .045) and involved margin showed 20.9 times risk of LRR compared to clear margin(95% CI 6.529-67.021, p < 0.0001). Primary resection margin on frozen section and pathological nodal status are the most important factors influencing LRR and DFS. This study highlights importance of aggressive treatment and close follow-up even with a single node involvement and when frozen section margin clearance is less than 5 mm.

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“…Lymph nodes were analyzed for nodal stage, extracapsular extension and lymph node ratio (defined as the ratio between the number of pathological cervical lymph nodes and the total number of resected cervical lymph nodes). 6 The site of recurrence was noted along with the duration of recurrence from the date of surgery. 7 Local recurrence was defined as the lesion at the site or adjacent to the primary tumor, which was completely treated.…”

Section: Methodsmentioning

confidence: 99%

Salvage surgery versus primary surgery for buccal mucosal squamous cell carcinoma and the need for neck dissection

Riju¹,

Mbbs²

2018

jmscr

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Background: Buccal mucosal squamous cell carcinoma (BSCC) is the most common oral malignancy. BSCC can be treated with Radiotherapy (RT) or surgery or multimodality treatment. This article deals with RT failure BSCC treated by surgery and its subsequent management. Material and Methods: This is a retrospective analysis done in a tertiary care cancer center. The study included 162 patients, of which 35 were treated for RT failure and 127 underwent a primary surgery. Histopathological factors like tumor stage, grade of differentiation, tumor front, skin involvement, bone involvement, depth of invasion, perineural invasion, lymphovascular emboli, primary resection margin in frozen section, nodal stage, extracapsular extension and lymph node ratio were analyzed and compared for LRR and DFS. Clinical neck nodal status was compared with pathological node status. Results: 2 years DFS following salvage surgery was 54.3% and primary surgery was 71.7 %. Following RT, tumor tends to be poorly differentiated (p=0.036) and with more incidence of perineural invasion (p=0.043). Nodal involvement was less in salvage group (11.4%) but when present, more than 1 nodal station got involved. The accuracy of finding a significant node by palpation in salvage patients was 14.28% compared to 54.3% in a primary setting. Conclusion: BSCC following RT had a poor prognosis. Hence primary surgery must be considered over RT for BSCC. Cervical node palpation was not accurate in salvage patients. Following imaging, if neck dissection is indicated, modified radical neck dissection is to be performed.

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Importance of lymph node ratio for locoregional recurrence of squamous cell carcinoma of the buccal mucosa

Abstract: Lymph node ratio is a useful parameter to stratify the risk of locoregional recurrence in patients with SCC of the buccal mucosa.

Cited by 22 publications

References 17 publications

Evaluation of lymph node ratio and lymph node yield as prognosticators of locoregional recurrence in p16‐associated oropharyngeal squamous cell carcinoma

Evaluation of lymph node ratio and lymph node yield as prognosticators of locoregional recurrence in p16‐associated oropharyngeal squamous cell carcinoma

Factors Influencing Locoregional Recurrence and Disease-Free Survival in Buccal Mucosal Squamous Cell Carcinoma

Salvage surgery versus primary surgery for buccal mucosal squamous cell carcinoma and the need for neck dissection

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