Squamous cell carcinoma of the maxillary gingiva, alveolus, and hard palate: is there a need for elective neck dissection?

Mourouzis, Constantinos; Pratt, C.; Brennan, Peter A.

doi:10.1016/j.bjoms.2009.07.012

Cited by 70 publications

(57 citation statements)

References 13 publications

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“…The rate of 13.3% of histopathological confirmed lymph node metastases recorded in the present study is below the listed range of 17-54% specifically mentioned for maxillary OSCC in related cohort studies [11,19,22,23,[27][28][29][30]. In 9.4% of patients with one-sided END (3/32), recurrent metastases occurred in the non-dissected side of the neck, that are assigned to initial clinical occult metastases by some authors and occur in 10-30% of the time [22,27,28,31], such as histopathological detected occult metastases after END [8,19,20,22,30] (Table 5). In the study of Mourouzis et al 2 out of 13 total patients with cN0-result developed cervical metastases (15%) in the course of 18 months [31].…”

Section: Discussionmentioning

confidence: 91%

“…In 9.4% of patients with one-sided END (3/32), recurrent metastases occurred in the non-dissected side of the neck, that are assigned to initial clinical occult metastases by some authors and occur in 10-30% of the time [22,27,28,31], such as histopathological detected occult metastases after END [8,19,20,22,30] (Table 5). In the study of Mourouzis et al 2 out of 13 total patients with cN0-result developed cervical metastases (15%) in the course of 18 months [31]. In 8 cN0 cases with only observation in the study of Montes et al 3 patients developed late cervical metastasis (38%) in the course of 16 months [27].…”

Section: Discussionmentioning

confidence: 99%

“…Simental et al assumed this connection in 2 patients, where after lymph node metastases occurred, a local recurrence was diagnosed within months. Likewise, an influence of [8,19,22,23,27,[29][30][31]. Despite lack of evidence, a presentation of second primary tumors in dysplastic epithelial fields must be considered [35].…”

Section: Discussionmentioning

confidence: 99%

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Metastatic pattern in squamous cell carcinoma of the hard palate and maxillary alveolar ridge: clinical experience and review of the literature

et al. 2017

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Purpose Oral squamous cell carcinoma of the hard palate and upper alveolar ridge is rare with only few published current data regarding regional metastases after elective neck dissection or adjuvant therapy. Our aim was to investigate the incidence of initial and delayed nodal metastasis and to identify predictive factors. Methods In a retrospective cohort study, we enrolled 48 primarily surgical-treated patients from 2004 to 2014. Results Pathological initial nodal metastasis rate was 13.3% (6/45). Poor histologic grade (p = 0.048), lymphovascular infiltration (p \ 0.001) and perineural infiltration (p = 0.01) correlated with initial nodal metastasis, while advanced T-stage showed no significance (p = 0.07). Regional recurrences occurred in 14.6% of patients (7/48) and tended to emerge less frequently after therapeutic than elective neck dissection. Tumor involvement of the vestibular alveolar mucosa was a prognostic factor for developing regional recurrence (p = 0.034). Overall nodal disease rate was 27.1% (13/48). Disease-free and overall survival rates were at 73 and 93%, respectively. Conclusions The presence of poor histologic characteristics is a high risk for nodal metastasis. In patients with tumors in contact with the upper vestibular fold, the hypothesis of an impact on metastasis needs further validation.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Metastatic pattern in squamous cell carcinoma of the hard palate and maxillary alveolar ridge: clinical experience and review of the literature

et al. 2017

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“…Size of the primary tumor and histological grade was significantly associated with survival, and clinical stage was the most important prognostic indicator [30] . Recent retrospective series with 26 to 146 upper alveolar ridge and hard palate cases reported a neck lymph node involvement between 11% and 36.6%, and regional recurrence in N0 neck from 14% to 27% [1,[5][6][7][8] . These studies had several findings: cases with neck node involvement had higher grade; clinical stage but not margin status was associated with prognosis; and T3 (55%) and T4 (52%) tumors exhibited higher rates of neck lymph node involvement than smaller tumors (T1 = 15%; T2 = 28%).…”

Section: Discussionmentioning

confidence: 99%

“…Prognostic factors and neck management in head and neck SCC (HNSCC) have been extensively studied in series of tongue or floor of mouth SCC, or on series with a mixture of SCC tumor sites [2] . Only small retrospective series have evaluated the behavior of hard palate and upper alveolus, and suggest that they have a low rate of regional node metastases [3][4][5][6][7][8] . However, recent studies find higher rates of both neck lymph node involvement and neck recurrence in these malignancies, and, there is a need to identify those aggressive cases that would benefit from more aggressive treatment [9,10] .…”

Section: Introductionmentioning

confidence: 99%

Nodal involvement and p16-staining in upper alveolar ridge and hard palate cancer

Salas¹,

Sanchez²,

Postigo³

et al. 2018

JCMT

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Aim: Upper alveolar ridge and hard palate squamous cancer is an infrequent malignancy. We evaluated factors associated with neck involvement and with p16-staining. Methods:Head and neck squamous-cell carcinoma (SCC) patients who went to Head and Neck Department between 1997 and 2011 were screened, and 73 resected upper alveolar ridge and 5 hard palate SCC were selected. Tumors with available tissue were stained with p16 immunohistochemistry.Results: Median age was 64.4 years, 55.1% were female, and 73.1% were in clinical stage IV. Neck dissections were performed in 24 and pathologically confirmed node metastases were found in 19 (24.3%). Cervical recurrence was found in 18 patients (23.1%) and was associated with histological grade (P = 0.037). Three (7.3%) of 41 lesions were positive for p16 and tended to be younger (P = 0.067). Lymphovascular invasion was associated with shorter disease-free survival (DFS) (P = 0.026) and overall survival (OS) (P = 0.021). Larger cT (P = 0.019), perineural invasion (P = 0.039) and neck dissection (P = 0.010) were associated with shorter OS. Neck node involvement tended to have shorter DFS (31% vs. 48.7%, P = 0.278) and OS (25.1% vs. 48.5%, P = 0.340), and neck recurrence tended to have shorter OS (9.3% vs. 52.3%, P = 0.064). Conclusion:Neck involvement and recurrence are frequent in this location. P16-positive cases were present in 7.3% and tended to be associated with younger age.

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Systematic review and meta‐analysis of cervical metastases in oral maxillary squamous cell carcinoma

et al. 2021

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Background: Management of the node-negative neck in oral maxillary squamous cell carcinoma (SCC), encompassing the hard palate and upper alveolar subsites of the oral cavity, is controversial, with no clear international consensus or recommendation regarding elective neck dissection in the absence of cervical metastases.Aim: To assess the occult metastatic rate in patients with clinically node negative oral maxillary SCC; both as an overall metastatic rate, and a comparison of patients managed with an elective neck dissection at index surgery, compared to excision of the primary with clinical observation of the neck. Methods and results:A systematic review was performed by two independent investigators for studies relating to oral maxillary SCC and analysed according to PRISMA criteria. Data were extracted from Pubmed, Ovid MEDLINE, EMBASE, and SCOPUS via relevant MeSH terms. Grey literature was searched through Google Scholar and OpenGrey. Five hundred and fifty-three articles were identified on the initial search, 483 unique articles underwent screening against eligibility criteria, and 29 studies were identified for final data extraction. Incidence of occult metastases in patients with clinically node negative oral maxillary SCC was identified either on primary elective neck dissection or on routine follow up. Meta-analyses were performed. Of 553 relevant articles identified on initial search, 29 were included for analysis. The pooled overall rate of occult metastases in patients initially presenting with clinically node-negative disease was 22.2%. There is a statistically significant effect of END on decreasing regional recurrence demonstrated in this study (RR 0.36, 95% CI 0.24, 0.59). Conclusion:The results of this systematic review and meta-analysis suggest elective neck dissection for patients presenting with hard palate or upper alveolar SCC, even in a clinically node negative neck.

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Squamous cell carcinoma of the maxillary gingiva, alveolus, and hard palate: is there a need for elective neck dissection?

Cited by 70 publications

References 13 publications

Metastatic pattern in squamous cell carcinoma of the hard palate and maxillary alveolar ridge: clinical experience and review of the literature

Metastatic pattern in squamous cell carcinoma of the hard palate and maxillary alveolar ridge: clinical experience and review of the literature

Nodal involvement and p16-staining in upper alveolar ridge and hard palate cancer

Systematic review and meta‐analysis of cervical metastases in oral maxillary squamous cell carcinoma

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