BACKGROUND: Elective neck dissection (END) is commonly used as a staging and therapeutic procedure for oral squamous cell carcinoma (SCC) at high risk of nodal metastases. The authors aimed to determine whether the extent of lymphadenectomy, as defined by nodal yield, is a prognostic factor in this setting. METHODS: A retrospective database review identified 225 patients undergoing END with curative intent for oral SCC between 1987 and 2009. Nodal yield was studied as a categorical variable for association with overall, disease-specific, and disease-free survival in univariate and multivariate analyses. RESULTS: Nodal yield <18 was associated with 5-year overall survival of 51% compared with 74% in those with nodal yield 18 (P ¼ .009). Five-year disease-specific survival rates were 69% in those with <18 nodes and 87% in patients with 18 nodes (P ¼ .022). Similar results were obtained for disease-free survival, with 5-year rates of 44% with <18 nodes versus 71% with 18 nodes (P ¼ .043). After adjusting for the effect of age, nodal status, T stage, and adjuvant radiotherapy on multivariate analysis, nodal yield <18 was associated with reduced overall (hazard ratio [HR], 2.0; 95% confidence interval [CI], 1.1-3.6; P ¼ .020), disease-specific (HR, 2.2; 95% CI, 1.1-4.5; P ¼ .043), and disease-free survival (HR, 1.7; 95% CI, 1.1-2.8; P ¼ .040). In the pathologically lymph nodenegative subgroup (n ¼ 148), similar results were obtained. CONCLUSIONS: Nodal yield is an independent prognostic factor in patients undergoing END for oral SCC. These results suggest that an adequate lymphadenectomy in this setting should include at least 18 nodes.
The LNR is an independent prognostic factor in OSCC and may be used in conjunction with the current TNM staging to enable better risk stratification and selection for adjuvant therapy.
BACKGROUND: A study was undertaken to determine whether bone invasion is an independent prognostic factor in oral squamous cell carcinoma (SCC) after taking into account the extent of bone invasion. METHODS: The study was a retrospective review of 498 patients with oral SCC undergoing surgery with curative intent, 102 of whom had pathologically proven bone invasion. Bone invasion was categorized as absent, cortical, or medullary and tested for association with disease control and survival. RESULTS: After adjusting for potential confounding factors in multivariate analysis, there was no association between cortical invasion and overall (P ¼ .48) or disease-specific survival (P ¼ .63). In contrast, medullary invasion was an independent predictor of reduced overall (hazard ratio [HR], 1.9; 95% confidence interval [CI], 1.2-3.1; P ¼ .006) and disease-specific survival (HR, 2.1; 95% CI, 1.2-3.6; P ¼ .01), and this appeared to result from an increased risk of distant metastatic failure (P ¼ .037) rather than local (P ¼ .51) or regional recurrence (P ¼ .14). Within the subset of patients with medullary invasion, survival differed significantly according to tumor size (P ¼ .029). CONCLUSIONS: Patients with oral SCC and bone invasion have widely variable outcomes depending on the depth of bone invasion and tumor size. The results suggest that the current American Joint Committee on Cancer staging system, which classifies all tumors invading through cortical bone as T4, has limited prognostic utility. The authors recommend a revision of the T staging system such that tumors are classified as T1 to T3 based on size and then upstaged by 1 T stage in the presence of medullary bone invasion. Cancer 2011;117:4460-7.
The LNR is an important independent prognostic factor in PTC and can be used in conjunction with existing staging systems. A clinical relevant cut-off point of 0.3 (one positive lymph node out of three total) is proposed. No prognostic implications for LNY were identified.
Multifocal PNI is associated with poor outcomes even with PORT suggesting consideration of therapeutic escalation, particularly with involved nerves ≥1 mm. Unifocal PNI did not affect prognosis even in the absence of PORT, which may not be required if this is the sole risk factor. Prospective validation and testing of these hypotheses is essential before implementation.
the relationship of these prognostic variables displays a dynamic interaction. Initial combined-modality treatment and shorter time to recurrence were associated with worse outcome, while the effect of site of recurrence (local vs regional) was dependent on an interaction with the time to recurrence. The result of this interaction was that local recurrence was worse for those who experienced it early (eg, <6 mo after the initial treatment) and nodal recurrence was worse for those who experienced it late (eg, ≥ 6 mo after the intial treatment).
Patients undergoing salvage surgery within 12 months, and in particular within 4 months, who have received high dose radiotherapy (>64 Gy) or concurrent chemoradiation are at high risk of developing PCF.
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