Lingual Lymph Node Metastasis in cT1-2N0 Tongue Squamous Cell Carcinoma: Is It an Indicator for Elective Neck Dissection

Abstract

Objective: Accurate predictors for occult metastasis in cT1-2N0 tongue squamous cell carcinoma (SCC) remains scarce, the main goal in current study was to evaluate whether there is significant association between lingual lymph node (LLN) metastasis and occult lymph node metastasis as well as whether there is prognostic value of LLN metastasis in early stage tongue SCC. Methods: Patients with surgically treated primary cT1-2N0 tongue SCC were prospectively enrolled from January 2010 to December 2018. LLNs were dissected independently for pathologic analysis. The main study endpoints were locoregional control survival (LRC) and disease-specific survival (DSS). The Chi-square test and multivariate regression analysis were used to assess the predictors for occult metastasis. The Kaplan-Meier approach and Cox model were used to analyze the potential prognostic factors. Results: A total of 317 patients were enrolled for analysis. Eighty-eight patients had occult metastasis with a prevalence of 27.8%. LLNs presented in 89 patients, in which 43 patients had LLN metastasis. In the 43 patients with positive LLNs, 20 patients had occult metastasis, in 274 patients with negative LLNs or no LLNs, 68 patients had occult metastasis, the difference was significant (p = 0.012). Further multivariate regression analysis confirmed the independence of LLN metastasis in predicting the occult metastasis. In patients without LLNs, the 5-year LRC rate was 79%, in patients with negative LLNs, the 5-year LRC rate was 78%, in patients with positive LLNs, the 5-year LRC rate was 62%, the difference was significant (p = 0.024). In patients without LLNs, the 5-year DSS rate was 84%, in patients with negative LLNs, the 5-year DSS rate was 74%, in patients with positive LLNs, the 5-year DSS rate was 51%, the difference was significant (p < 0.001), further Cox model confirmed the independence of LLN metastasis in affecting the LRC and DSS. Conclusions: LLN metastasis is significantly associated with occult neck lymph node metastasis, and decrease the LRC and DSS in early stage tongue SCC.

Prognosticators and Management of Oral Tongue Squamous Cell Carcinoma

“…Furthermore (79.3%) of the patients in this study were found to have it while only (18.8%) of them were clear of any pathologic lymph nodes, in closely similar findings to Nootan Kumar Shukla who found that (56.4%) of the patients in his study had positive pathologic lymph nodes with the rest being clear of it [17], in contrast to Tao Zbang et al who found that only (9.2%) of the patients in his study had positive pathologic lymphnodes [27]. Concerning the adjuvant therapy (50.7%) did not have any type of adjuvant therapy, (21.7%) had radiotherapy and only (1.4%) had chemotherapy, in agreement to Wenli Yang et al who found that (68.5%) of the patients in their study did not undergo adjuvant therapy with only (31.5%) of them having to go through with it [28], in contrast to Nootan Kumar Shukla et al who found that (78.5%) of the patients in their study had adjuvant therapy with the rest of them were not advised to have adjuvant therapy [17]. About the site of recurrence (44.9%) of the patients in this study did not experience recurrence, (4.3%) had local recurrence, and only (1.4%) of the patients had locoregional recurrence, in closely similar findings to Nootan Kumar Shukla et al who found that only (8.8% and 10.4%) of the patients in his study experienced local and regional recurrences respectively [17], in contrast to Jeffrey C et al who found that (63%) of the patients in his study experienced local recurrence [29].…”

Lingual Lymph Node Metastases as a Prognostic Factor in Oral Squamous Cell Carcinoma—A Retrospective Multicenter Study

“…In this study, however, pretreatment NLR was not significantly different between LLN-positive and LLN-negative patients. Pretreatment NLR may be a non-specific parameter because it could be influenced by concomitant conditions, such as infections or inflammation [ 17 ]. In the current study, multivariate analysis revealed clinical neck node metastasis as an independent risk factor of LLN metastasis, which corresponded with previous reports [ 14 , 15 ].…”

Pretreatment Blood Markers in the Prediction of Occult Neck Metastasis: A 10-Year Retrospective Study

“…Various references have demonstrated the role of histopathologic parameters of the primary tumor, such as tumor size [25][26][27], DOI [25,26,28], tumor thickness [25,27,28], differentiation grade [25,26], perivascular/perineural invasion [27,29] as possible predictors of occult neck metastasis. Our study confirms the role of tumor size, differentiation grade and perivascular/perineural invasion in accurately staging the clinically negative neck in early-stage OSCC of the tongue.…”