Microvascular Invasion in Cancer of the Oral Cavity and Oropharynx

Abstract

\s=b\The presence of squamous cell carcinoma within capillaries and/or venules in the immediate vicinity of primary lesions of the oral cavity and oropharynx may be related to regional lymph node metastasis. To evaluate this possibility, we have reviewed the clinical and histopathologic features of 43 consecutive cases of previously untreated T2 or greater squamous cell carcinoma of these sites managed with simultaneous surgical treatment of the primary neoplasm and the neck. The incidence of histologically proved cervical metastasis for all lesions with vascular invasion compared with those without vascular involvement was highly significant. No statistical correlation was found for the clinical stage of neck disease or for the other pathologic features of the primary tumor, ie, size, appearance, differentiation, depth of invasion, periphery of lesion, inflammatory infiltrate, and perineural invasion, when compared with the histopathologic status of regional lymph nodes. TX 75235 (Dr Close).The presence or absence of histo¬ logically proved metastasis in regional lymph nodes is the single most important prognostic factor in squamous cell carcinoma of the oral cavity and oropharynx.1 The preopera¬ tive identification of patients with histologically proved lymph node involvement, however, has proved elu¬ sive. The results of clinical examina¬ tion of the neck, even by skilled head and neck surgeons, have been shown to be unreliable, especially in patients with cancer of the oral cavity or oro¬ pharynx.2 In a large series of patients treated surgically for squamous cell carcinoma of these sites (oral cavity and oropharynx), and with histologie evaluation of regional lymph nodes, the reported incidence of false-posi¬ tive clinical evaluation has ranged from 10% to 33%.'3 Similarly, the incidence of clinically occult cervical metastasis (false-negatives) has been reported as 15% to 40% in patients undergoing elective neck dissection for squamous cell carcinomas of the oral cavity and oropharynx.1·2·4·5Predictably, then, successful surgi¬ cal control of primary cancers of these sites, even in early lesions, is no assur¬ ance of cure, because of the strong likelihood of subsequent involvement of regional nodes. The incidence of cervical node metastasis following surgical treatment of the primary tumor alone in stage I and II oral cavity cancers has been reported as 30% to 42%.<-9 Unfortunately, only 35% of patients presenting with sub¬ sequent cervical node disease have been successfully salvaged.78 Results of clinical studies have suggested, however, an advantage for patients treated aggressively for occult region¬ al node disease. Cunningham et al6 were able to demonstrate a slightly improved prognosis for patients with oral cavity cancer treated with elec¬ tive neck dissection compared with those with no evidence of clinical neck disease treated by observation and salvage surgery when necessary. Like¬ wise, the results of two large series of patients treated for oral cavity and oropharyngeal cancer and reported by S...

Predictive value of laminin-5 and membrane type 1-matrix metalloproteinase expression for cervical lymph node metastasis in T1 and T2 squamous cell carcinomas of the tongue and floor of the mouth

“…Furthermore, several studies demonstrated that tumor thickness was also associated with latent lymph node metastasis in patients with N0 disease 24–26. On the contrary, we did not observe a statistical relationship between tumor thickness and the occurrence of latent metastasis, which is consistent with the results of Brown et al48 and Close et al49 Instead, enhanced expression of both Ln‐5 and MT1‐MMP and invasion of the infiltrative type were found to be parameters associated with latent metastasis, and the former was the only independent predictor by multivariate analysis. Metastasis occurs as the culmination of a series of highly selective events, and most tumor cells die in lymphatic vessels and lymph nodes 50.…”

Chlorine and Chromium Elements, Proteins of Oxidative Stress and Dna Repair Pathways Are Related to Tumor Aggressiveness and Prognosis of Patients With Oral Cancer

“…The results of this study respecting the relationships between the histopathological characteristics of OSCC tumors and the data of the clinical evolution of the patients were con rmatory of the reports from the literature [17][18][19][20][21][22][23]. In several previous studies, the presence of vascular and perineural invasion of the tumor has been related with worse prognosis, i.e., disease relapse, shorter survival and higher death rates [21,23].…”

Development of distant metastasis after treatment of advanced-stage head and neck cancer

“…The difference in behavior between the varying grades of SCC has not been substantiated in other studies 20,21 . Similarly, only approximately one-third of our patients with DM had poorly differentiated cancer and the difference between the two groups was not statistically significant.…”