Multi‐center retrospective study of the prognosis and treatment outcomes of Japanese oral squamous cell carcinoma patients with single lymph node metastasis and extra nodal extension

Hasegawa, Takumi; Yanamoto, Souichi; Otsuru, Mitsunobu; Kakei, Yasumasa; Okura, Masaya; Yamakawa, Nobuhiro; Yamada, Shin‐ichi; Ota, Yoshihide; Umeda, Masahiro; Kirita, Tadaaki; Kitamura, Hiroshi; Komori, Takahide

doi:10.1002/jso.25083

Cited by 9 publications

(6 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nineteen studies with full texts were reviewed, and four studies were excluded for specific reasons (Table 1 ). 18 , 19 , 20 , 21 Finally, 15 were eligible for the qualitative analysis, and 10 of which were eligible for the quantitative analysis. 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 22 , 23 , 24 , 25 , 26 , 27 , 28 …”

Section: Resultsmentioning

confidence: 99%

Postoperative radiotherapy versus surgery alone in pN1 oral cavity cancer patients: A meta‐analysis

Tsai,

Chiang,

Yap

et al. 2024

Laryngoscope Investig Oto

View full text Add to dashboard Cite

ObjectivesThe aim of this meta‐analysis is to evaluate the potential benefits of postoperative radiotherapy (PORT) in patients with pN1 oral cavity squamous cell carcinoma.MethodsA literature search through major databases was conducted until January 2023. The adjusted hazard ratio (aHR) or risk ratio (RR) with 95% confidence intervals (CIs) of different survival outcomes were extracted and pooled.ResultsTen studies published between 2005 and 2022, with a pooled patient population of 2888, were included in this meta‐analysis. Due to differences in study design and reported outcomes, the studies were categorized into distinct groups. In pN1 patients without extranodal extension (ENE), PORT was associated with a significant improvement in overall survival (OS) (aHR 0.76, 95% CI: 0.61–0.94). In pN1 patients without ENE and positive margins, PORT improved OS (aHR 0.71, 95% CI: 0.56–0.89) and was associated with a lower regional recurrence rate (RR 0.35, 95% CI: 0.15–0.83). However, in pN1 patients without ENE, positive margins, perineural invasion, and lymphovascular invasion, there were no significant differences observed between the PORT and observation groups in either 5‐year OS (RR 0.48, 95% CI: 0.07–3.41) or 5‐year disease‐free survival (RR 0.37, 95% CI: 0.07–2.06).ConclusionsThe current study demonstrated that PORT has the potential to improve OS in pN1 disease. However, the decision of whether to administer PORT still hinges on diverse clinical scenarios, and additional research is necessary to furnish a more conclusive resolution.Level of Evidence2.

show abstract

Section: Resultsmentioning

confidence: 99%

Postoperative radiotherapy versus surgery alone in pN1 oral cavity cancer patients: A meta‐analysis

Tsai,

Chiang,

Yap

et al. 2024

Laryngoscope Investig Oto

View full text Add to dashboard Cite

show abstract

“…In an effort to provide a sufficient answer and an evidencebased recommendation for the relatively rare case of pT1-2 pN1 situation, several retrospective studies have been carried out (8)(9)(10)(11)(12)(13)(14). Among the relatively inhomogeneous studies, including different adverse pathological features, competing risk factors and patients' characteristics, publications analyzing the US National Cancer Database have drawn attention, mainly because of the large number of patients included in the analyses (15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

The Benefit of Postoperative Radiotherapy and Extending Neck Dissection in pT1-2 Oral Squamous Cell Carcinoma With a Single Ipsilateral Cervical Lymph Node Metastasis (pN1)

et al. 2021

View full text Add to dashboard Cite

Background/Aim: We compared postoperative radiotherapy (PORT) to surgery only (SO), and supraomohyoidal neck dissection (SOHND) to modified radical neck dissection (MRND) in patients with pT1-T2 squamous cell carcinomas of the oral cavity (OSCC) and a single cervical lymph node metastasis (pN1) in terms of overall survival (OS), oral cancer specific survival (OCSS), and regional recurrencefree survival (RRFS), in a prospective cohort study. Patients and Methods: We included patients with pT1-T2 pN1 OSCC with no distant metastasis and estimated the survival probabilities using the Kaplan-Meier method and calculated hazards ratios (HR) for PORT vs. SO and MRND vs. SOHND using adjusted Cox regression models. Results: A total of 51 patients (26 SO vs. 25 PORT, 9 SOHND vs. 42 MRND) were evaluated. Patients who received PORT were more likely to be younger and healthier. OS at 5 years was 41% and 87% in the SO and PORT groups, respectively. OS at 5 years was 52% and 67% in the in the SOHND and MRND groups, respectively. Both OCSS and RRFS were improved by PORT.Extending neck dissection was not associated with improved OS (HR = 0.83). Conclusion: PORT is associated with preferable OS, OCSS, and RRFS in pT1-2 pN1 oral cancer and should be recommended regularly.

show abstract

“…Nevertheless, the impact of ENE was quite subtle, as marked discrepancies in survival rates for OCSCC patients could be discerned between different studies, ranging from 66.6% to 38.9% 17 - 19 . Some even asserted that more than 2 ENE nodes would confer unfavorable prognoses, while single ENE nodes did not affect overall survival 21 . Others considered that the unfavorable distributions (lower levels) of multiple ENE nodes would constitute risk factors 27 , 33 .…”

Section: Discussionmentioning

confidence: 99%

“…Shaw also confirmed this claim, with reported OS rates of 65%, 52% and 23% for node-negative, node-positive (ENE-negative) and node-positive (ENE-positive) patients, respectively 17 . Despite these findings, the full influence of ENE has not yet been elucidated, as most studies still consider ENE as a single pathologic event when grading patients with OCSCC 20 - 21 . Nevertheless, few reports have focused on the clinical dilemmas for those with bilateral multilevel MLNs with ENE features.…”

Section: Introductionmentioning

confidence: 99%

Extranodal Extension in Bilateral Cervical Metastases: A predictor of Undesirable Survival Outcomes despite Aggressive Salvage Treatment in Oral Cancer Patients

Gao

Zhu

et al. 2021

J. Cancer

View full text Add to dashboard Cite

Objectives: Despite the inclusion of extranodal extension (ENE) in the recent staging system, the presence of ENE alone is not sufficient to depict all clinical situations, as ENE is frequently found in multiple nodes. Thus, the purpose of this study was to evaluate the surgery-based treatment outcomes and clinicopathological features of oral cavity squamous cell carcinoma (OCSCC) patients with ENE found in bilateral multiple cervical metastases. Materials and methods: A retrospective single-institutional study of OCSCC patients with bilateral ENE nodes was performed from January 2011 to December 2018. OCSCC patients of different admission statuses (with primary lesions (PL), recurrent lesions (RL) and isolated neck metastases (INM)) were included for subgroup comparisons. All patients received surgical treatment with/without adjuvant therapies and had complete follow-up data. Disease-free survival (DFS) was regarded as the main outcome. Time-to-relapse data were also collected for comparison. Results: A total of 128 patients were included, of whom 97 (75.8%) were male. The mean follow-up period reached 15 months. Among the patients, 85 (66.4%) were treated for PLs, followed by 26 (20.3%) treated for RLs after failed prior therapy and 17 (13.3%) treated for INMs (concurrent or sequential). The DFS rate was merely 35.2%. Treatment-related factors such as surgical margin (p=0.003), postoperative adjuvant therapy (p=0.014) and perioperative complications (p=0.036) were significantly associated with patient outcomes. In addition, oral lesion-related variables such as oral subsites (p=0.037), T classification (p=0.026) and skull base involvement (p=0.040) were indicators of a worse prognosis. For bilateral ENE features, ENE subclassification (p=0.036), maximum size of ENE nodes (p=0.039) and arterial nodal encasement (p=0.025) tended to predict the surgery-based treatment outcomes of these patients. Conclusions: Bilateral cervical metastases with ENE features, though uncommon, are a serious regional burden, and these patients have lower-than-expected treatment outcomes, especially those with RLs or INMs. A fairly large number of OCSCC patients with advanced oral lesions gain little benefit from intensified salvage surgical treatment. Such treatment should instead be offered to select patients with smaller bilateral ENE nodes (<3 cm) and those with lower ENE subclassifications and no arterial nodal encasement.

show abstract

Multi‐center retrospective study of the prognosis and treatment outcomes of Japanese oral squamous cell carcinoma patients with single lymph node metastasis and extra nodal extension

Abstract: The prognosis of ENE + pN1 was not as poor as that of ENE + MLM, although both these groups feature ENE. Adjuvant therapy (RT/CCRT) after surgery is recommend for cases of ENE + pN1.

Cited by 9 publications

References 26 publications

Postoperative radiotherapy versus surgery alone in pN1 oral cavity cancer patients: A meta‐analysis

Postoperative radiotherapy versus surgery alone in pN1 oral cavity cancer patients: A meta‐analysis

The Benefit of Postoperative Radiotherapy and Extending Neck Dissection in pT1-2 Oral Squamous Cell Carcinoma With a Single Ipsilateral Cervical Lymph Node Metastasis (pN1)

Extranodal Extension in Bilateral Cervical Metastases: A predictor of Undesirable Survival Outcomes despite Aggressive Salvage Treatment in Oral Cancer Patients

Contact Info

Product

Resources

About