Tumour infiltration depth ⩾4mm is an indication for an elective neck dissection in pT1cN0 oral squamous cell carcinoma

Abstract

Patients with pT1cN0 oral squamous cell carcinomas (OSCC) are generally not treated with a neck dissection (ND). However, in 25% of cN0 patients, nodal metastases become apparent during follow-up. Infiltration depth of the primary tumour has been consistently associated with the presence of nodal metastasis, but proposed cut-off depths for performing a ND vary considerably. The aim of this study was to explore the infiltration depth as predictor for the nodal status and to recommend a cut-off depth for performing a ND. From our database of 351 primary oral carcinomas, we selected all pT1-2 tumours (n=246). Infiltration depth was measured in 212 cases. Neck status was determined by histopathological examination of the dissection specimen, or by at least two years of follow-up. Mean infiltration depth was 5.49 mm (95% CI: 4.86-6.12) in the N0 and 8.40 mm (95% CI: 7.38-9.43) in the N+ group (p<0.001). cN status, lymphovascular invasion and infiltration depth were the only independent predictors for nodal status in multiple logistic regression. ROC-analysis on pT1cN0 tumours resulted in an optimal cut-off for the prediction of the nodal status at a depth of 4.59 mm. This cut-off identified a subgroup of patients at increased risk for nodal metastasis (OR=8.3) and with significantly shorter survival. Tumour infiltration depth is an independent predictor for nodal status in pT1-2 OSCC. In pT1cN0 tumours, a cut-off at 4.59 mm results in the best predictive value. We recommend an infiltration depth of ≥4 mm as an indication to perform a neck dissection in pT1cN0 OSCC.

Epithelial‐Mesenchymal Transition: Clinical Implications for Nodal Metastasis and Prognosis of Tongue Cancer

“…But, depth of invasion was not a risk factor of tumor recurrence in this study. [31][32][33][34] In cases with complete EMT phenotype and 4 mm depth of invasion, most cases (87.5%) showed lymph node metastasis. And in those cases where depth of invasion is less than 4 mm in the presence of a complete EMT phenotype, all cases showed lymph node metastasis.…”

Gene Expression Analysis As a Tool in Early-Stage Oral Cancer Management

“…6 To avoid the substantial risk of delayed detection and treatment, 7,8 elective neck dissection has been recommended for cN0 patients with a tumor invasion depth of 4 mm or greater. 9 Neck dissection provides nearly definitive information about nodal metastasis. If no positive nodes are found, there is little risk of regional recurrence.…”

“…If no positive nodes are found, there is little risk of regional recurrence. [5][6][7][8][9][10] Elective neck dissection alone can often represent sufficient treatment for early-stage disease, while guiding the use of adjuvant radiation and chemotherapy when indicated. Nevertheless, with approximately 70% of cN0 cases also pN0, elective neck dissection raises concern over unnecessary surgery and its associated morbidity.…”

Oral Mukozanın Malign Hastalıkları

“…Eksternal radyasyon tedavisinde çevre sağlıklı dokuların da ışına maruz kalma riski göz önüne alınarak, doğrudan tümör kitlesinin içine yerleştirilen iğne, teller, kateter gibi internal radyasyon tedavi yöntemleri uygulanabilir. Tümörün evresi, lokalizasyonu, metastaz, vasküler invazyonun varlığı, sigara önemli prognostik faktörlerdir 1,12,13 .…”