Relationship of Tumor Thickness with Neck Node Metastasis in Buccal Squamous Cell Carcinoma: An Experience at a Tertiary Care Hospital

Abstract

Introduction Squamous cell carcinoma is the most common malignancy of the head and neck, with the buccal mucosa being the most common site involved. Early locoregional metastasis is a hallmark of this disease, and early stage tumors may harbor metastatic nodes that are occult. Certain parameters can help identify high-risk patients for whom the pattern of occult nodal metastasis can be predicted. Tumor thickness is one such objective parameter. Objective To determine the relationship of tumor thickness with neck node metastasis in squamous cell carcinoma of the buccal mucosa. Methods A retrospective chart review of 102 patients with biopsy-proven squamous cell carcinoma of the buccal mucosa with N 0 Necks was performed. All patients underwent tumor resection with neck dissection, and the tumor thickness was measured. Univariate and multivariate analyses were performed. Results A total of 102 patients, of which 73.53% were males and 26.47% were females. The mean age of the patients was 49.3 ± 11.1 years. It was found that the risk of neck node metastasis in buccal squamous cell carcinoma increases 35.5 times for a tumor thickness ≥ 2 mm, and the risk of neck node metastasis in buccal squamous cell carcinoma decreases by 0.58 times for each centimeter decrease in tumor size, while the rate of occult neck lymph node metastasis was found to be 37%. Conclusion We conclude that tumor thickness is significantly related with neck nodal metastasis in buccal squamous cell carcinoma, considering the age of the patient and the size of the tumor.

Evaluation of Depth of Invasion and Tumor Thickness as a Prognostic Factor for Early-Stage Oral Squamous Cell Carcinoma: A Retrospective Study

“…The previous studies also included all subsites, such as tongue, mouth floor, retromolar trigone, gingiva, buccal mucosa, hard palate, and even lip [ 7 , 15 ]. However, many studies performed analyses only on oral tongue cancer [ 6 , 8 , 10 , 12 , 14 , 16 , 18 ] or the buccal cheek [ 5 ]. As the tongue is the most common subsite of oral squamous cell carcinoma (OSCC) and has a higher risk of cervical lymph node metastasis than other subsites with regard to its abundant lymphatics and mouth floor [ 8 ], lots of studies analyzed the pathology of oral tongue squamous cell carcinoma (OTSCC).…”

“…After the most recent revision of the AJCC Staging Manual was published, the differences between DOI and TT were emphasized, and the precise definitions of each were regarded as important. DOI is measured from the adjacent normal basement membrane to the deepest point of the tumor in millimeters, whereas TT is measured from the highest point of the tumor surface to the deepest point of the tumor in millimeters [ 5 , 6 , 7 , 8 , 9 , 10 ]. Depending on its morphology, TT can either overvalue or undervalue tumor invasiveness.…”

Clinicopathologic predictors of survival in buccal squamous cell carcinoma

“…DOI has been repeatedly identified as an adverse survival prognosticator in pooled studies including oral SCCs from various anatomic subsites 18,19 . Specifically in buccal SCCs, DOI has been associated with the development of lymph node metastases, 20,21 a finding also seen in the present study. We also demonstrated positive associations between DOI and several other clinicopathologic factors, most interestingly WPOI, a finding which has not been previously reported.…”

Oral Squamous Cell Carcinoma in Relation with Depth of Invasion and Lymph Node Metastasis

“…The most common site of occurrence was tongue (60%), followed by lower alveolus (20%) and most of the cases (60%) were well differentiated (Grade I These findings were in accordance with other studies. [9][10][11][12][13][14] In a study done by Hegde P et al, it was revealed that depth of invasion was a prognostic factor for nodal metastasis in oral squamous cell carcinoma. 15 Another study by Wermker et al, in 2015 revealed tumor extent, depth of infiltration, and grading as the most important factors of lymph node metastasis.…”