Oncologic outcome of marginal mandibulectomy in squamous cell carcinoma of the lower gingiva

Abstract

Background There is a large amount of controversy about the best management of the mandible in oral squamous cell carcinoma (SCC), mainly owing to the inability to acquire accurate bone invasion status. Therefore, our goal was to analyse the oncologic safety in patients undergoing marginal mandibulectomy (MM) for cT1-2 N0 SCC of the lower gingiva. Methods Patients undergoing MM for untreated cT1-2 N0 SCC of the lower gingiva were retrospectively enrolled. The main endpoints of interest were locoregional control (LRC) and disease-specific survival (DSS). Results A total of 142 patients were included in the analysis, and a pathologic positive node was noted in 27 patients. Cortical invasion was reported in 23 patients, and medullary invasion was reported in 9 patients. The 5-year LRC and DSS rates were 85 and 88%, respectively. Patients with bone invasion had a significantly higher risk for recurrence than patients without bone invasion. However, the DSS was similar in patients with versus without bone invasion. Patients with a high neutrophil lymphocyte ratio had a higher risk for worse prognosis. Conclusions The oncologic outcome in patients undergoing MM for cT1-2 N0 SCC of the lower gingiva was favourable; bone invasion was not uncommon, but it significantly decreased the prognosis in patients undergoing MM.

Significance of SUV Max for Predicting Occult Lymph Node Metastasis and Prognosis in Early-Stage Tongue Squamous Cell Carcinoma

“…is finding was consistent with previous studies [21][22][23]. Poor tumor differentiation was indicated by a higher Ki-67 index, a higher SUV max value, and an enhanced invasion ability of cancer cells [24].…”

Feasibility of Submandibular Gland Preservation in cT1-2N0 Squamous Cell Carcinoma in the Floor of the Mouth

“…Level 1b metastasis is the most common metastatic site in oral SCC (15,22,23), but only a few authors have analyzed the metastatic pattern in level 1b metastasis. DiNardo et al (4) might have been the first to describe that 10 (24.4%) of 41 patients FIGURE 5 | Comparison of locoregional control between pN0/pN+ patients with submandibular gland (SMG) preservation and patients with SMG excision (pN0: p = 0.243; pN+: p = 0.397).…”

“…All pathologic sections were re-reviewed by at least two pathologists, and PNI was considered to be present if tumor cells were identified within the perineural space and/or nerve bundle; LVI was positive if tumor cells were noted within the lymphovascular channels (15)(16)(17)(18). A cT1-2 tumor referred to a tumor whose long diameter was not more than 2 cm or ranged from 2 to 4 cm, and a cN0 neck referred to a neck that did not have any suspicious lymph nodes based on palpation and preoperative ultrasound, CT and MRI examinations.…”

“…Primary tumor excision with at least 1 cm margins was usually performed without lip splitting. After treatment, the patients were examined every 3 months during the first year, every 6 months during the second year, and once per year after the second year (15)(16)(17)(18). Once disease recurrence was suspected, aspiration biopsy or incisional biopsy combined with other examinations was performed.…”

Elective neck dissection versus wait-and-see policy in cT1N0 buccal squamous cell carcinoma

“…All pathologic sections were reviewed by at least two pathologists. Perineural invasion (PNI) was considered to be present if tumor cells were identified within the perineural space and/ or nerve bundle; lymphovascular infiltration (LVI) was positive if tumor cells were noted within the lymphovascular channels [16,17]. The depth of invasion was measured from the level of the adjacent normal mucosa to the deepest point of tumor infiltration, regardless of the presence or absence of ulceration.…”