Lymph node characteristics and their prognostic significance in oral squamous cell carcinoma

Arun, Indu; Maity, Namrata; Hameed, Shahin; Jain, Prateek; Manikantan, Kapila; Sharan, Rajeev; Arun, Pattatheyil

doi:10.1002/hed.26499

Cited by 45 publications

(44 citation statements)

References 36 publications

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“…The limitations of our work include the retrospective design and the limited number of patients; we also cannot recommend a clinical LNR cutoff that usefully identifies patients who might benefit from more intensive adjuvant therapy. Prospective studies and further considerations on various histopathologic lymph node‐based biomarkers are required 34–36 …”

Section: Discussionmentioning

confidence: 99%

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Comparing prognostic utility between the 8th edition of TNM staging system and the lymph node ratio for oral squamous cell carcinoma

et al. 2021

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Background Lymph node metastasis in oral squamous cell carcinoma (OSCC) is associated with poor prognosis. The 8th edition of TNM has implemented new nodal staging criteria. We assess the prognostic utility of the lymph node ratio (LNR) and compare it to that of pN in the TNM 8th edition. Methods One hundred and forty‐two patients with OSCC were retrospectively studied. Nodal staging was performed using the TMN 8th edition and the prognostic value of the LNR in terms of overall survival (OS) and disease‐free survival (DFS) was evaluated. Results Fifty‐seven patients were eligible for inclusion. The LNR was independently prognostic of OS (p = 0.02). Instead N classification was not significantly predictive of OS (p = 0.10). High LNRs resulted in decreases in OS of approximately 40% within 6 months after surgery. Conclusions The LNR identifies patients with poor outcomes better than N classification. The lack of reliable LNR cutoffs compromises its utility in clinical practice.

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Section: Discussionmentioning

confidence: 99%

“…Prospective studies and further considerations on various histopathologic lymph node-based biomarkers are required. [34][35][36] Lymph node status is the principal prognostic indicator of both OS and DFS in patients with OSCC. Many reports have shown that the LNR predicts survival.…”

Section: Lower Gingiva 18mentioning

confidence: 99%

Comparing prognostic utility between the 8th edition of TNM staging system and the lymph node ratio for oral squamous cell carcinoma

et al. 2021

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“…90%) show 5 mm or less of extension beyond the capsule, and the average extent is typically around 2 mm. 37,38 Evidence is emerging that 2 mm may be an important cutoff point, but data are limited and conflicting. Wreesmann et al 39 used receiver operating characteristics curve analysis to determine that 1.7 mm or less of extranodal extension had the same disease-specific survival as no extranodal extension in oral cavity SCC, whereas those with more than 1.7 mm of extranodal extension fared worse, including in multivariate analysis.…”

Section: Figure 1 Lymph Node Metastases Without Pathologic Extranodal Extensionmentioning

confidence: 99%

Assessment Criteria and Clinical Implications of Extranodal Extension in Head and Neck Cancer

Huang

Chernock

Fakhry

2021

American Society of Clinical Oncology Educational Book

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Tumor breaching the capsule of a lymph node is termed extranodal extension (ENE). It reflects aggressiveness of a tumor, creates anatomic challenges for disease clearance, and increases the risk of distant metastasis. Extranodal extension can be assessed on a pathology specimen, by radiology studies, and by clinical examination. Presence of ENE in a pathology specimen has long been considered a high-risk feature of disease progression and would ordinarily benefit from the addition of chemotherapy to adjuvant radiotherapy. Although the eighth edition of the Union for International Cancer Control/American Joint Committee on Cancer stage classification dichotomizes pathologic ENE according to its presence or absence, emerging evidence suggests that the extent of a pathologic ENE may provide additional value for risk stratification to guide adjuvant therapy. Recent data suggest that the prognostic importance of pathologic ENE is also applicable for HPV-associated head and neck squamous cell carcinoma. In addition, compelling data demonstrate that indisputable radiologic ENE is a powerful risk stratification tool to identify patients at high risk for treatment failure, especially distant metastasis, applicable for both HPV-positive and HPV-negative head and neck squamous cell carcinoma. However, the definition and taxonomy of radiologic ENE requires standardization. The goal of this review is to clarify the contemporary understanding of the prognostic implications of ENE in head and neck squamous cell carcinoma, present the nuances of what is presently known and unknown, and elucidate how to classify ENE pathologically and radiologically with an understanding of the strengths and weaknesses of each approach. Finally, with the development of several risk stratification methods, the relative role of ENE and other prognostic schema will be explored.

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“…ENE features can be found in metastatic nodes of different sizes and different levels of invasion and in OCSCC patients with either primary or recurrent lesions 24 . Although patients with ENE nodes would most likely receive augmented treatment regimens, the outcomes available in the literature were vastly different, showing varying treatment benefits among OCSCC patients 25 - 27 . As was shown in our study, those with unilateral ENE nodes enjoyed much better DFS results than those with bilateral ones.…”

Section: Discussionmentioning

confidence: 99%

“…Some even asserted that more than 2 ENE nodes would confer unfavorable prognoses, while single ENE nodes did not affect overall survival 21 . Others considered that the unfavorable distributions (lower levels) of multiple ENE nodes would constitute risk factors 27 , 33 . However, the MLN burden with bilateral ENE features might have strong relations to an inferior DFS, as demonstrated in our study.…”

Section: Discussionmentioning

confidence: 99%

Extranodal Extension in Bilateral Cervical Metastases: A predictor of Undesirable Survival Outcomes despite Aggressive Salvage Treatment in Oral Cancer Patients

Gao

Zhu

et al. 2021

J. Cancer

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Objectives: Despite the inclusion of extranodal extension (ENE) in the recent staging system, the presence of ENE alone is not sufficient to depict all clinical situations, as ENE is frequently found in multiple nodes. Thus, the purpose of this study was to evaluate the surgery-based treatment outcomes and clinicopathological features of oral cavity squamous cell carcinoma (OCSCC) patients with ENE found in bilateral multiple cervical metastases. Materials and methods: A retrospective single-institutional study of OCSCC patients with bilateral ENE nodes was performed from January 2011 to December 2018. OCSCC patients of different admission statuses (with primary lesions (PL), recurrent lesions (RL) and isolated neck metastases (INM)) were included for subgroup comparisons. All patients received surgical treatment with/without adjuvant therapies and had complete follow-up data. Disease-free survival (DFS) was regarded as the main outcome. Time-to-relapse data were also collected for comparison. Results: A total of 128 patients were included, of whom 97 (75.8%) were male. The mean follow-up period reached 15 months. Among the patients, 85 (66.4%) were treated for PLs, followed by 26 (20.3%) treated for RLs after failed prior therapy and 17 (13.3%) treated for INMs (concurrent or sequential). The DFS rate was merely 35.2%. Treatment-related factors such as surgical margin (p=0.003), postoperative adjuvant therapy (p=0.014) and perioperative complications (p=0.036) were significantly associated with patient outcomes. In addition, oral lesion-related variables such as oral subsites (p=0.037), T classification (p=0.026) and skull base involvement (p=0.040) were indicators of a worse prognosis. For bilateral ENE features, ENE subclassification (p=0.036), maximum size of ENE nodes (p=0.039) and arterial nodal encasement (p=0.025) tended to predict the surgery-based treatment outcomes of these patients. Conclusions: Bilateral cervical metastases with ENE features, though uncommon, are a serious regional burden, and these patients have lower-than-expected treatment outcomes, especially those with RLs or INMs. A fairly large number of OCSCC patients with advanced oral lesions gain little benefit from intensified salvage surgical treatment. Such treatment should instead be offered to select patients with smaller bilateral ENE nodes (<3 cm) and those with lower ENE subclassifications and no arterial nodal encasement.

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Lymph node characteristics and their prognostic significance in oral squamous cell carcinoma

Cited by 45 publications

References 36 publications

Comparing prognostic utility between the 8th edition of TNM staging system and the lymph node ratio for oral squamous cell carcinoma

Comparing prognostic utility between the 8th edition of TNM staging system and the lymph node ratio for oral squamous cell carcinoma

Assessment Criteria and Clinical Implications of Extranodal Extension in Head and Neck Cancer

Extranodal Extension in Bilateral Cervical Metastases: A predictor of Undesirable Survival Outcomes despite Aggressive Salvage Treatment in Oral Cancer Patients

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