Oral maxillary squamous carcinoma: An indication for neck dissection in the clinically negative neck

Montes, David M.; Carlson, Eric R.; Fernandes, Rui; Ghali, G.E.; Lubek, Joshua E.; Ord, Robert A.; Bell, R. Bryan; Dierks, Eric J.; Schmidt, Brian L.

doi:10.1002/hed.21631

Cited by 48 publications

(64 citation statements)

References 27 publications

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“…Similar to recent reports about the role of histologic risk factors [26], in our study, perineural or lymphovascular invasion was significantly associated with initial positive nodes. The rate of 13.3% of histopathological confirmed lymph node metastases recorded in the present study is below the listed range of 17-54% specifically mentioned for maxillary OSCC in related cohort studies [11,19,22,23,[27][28][29][30]. In 9.4% of patients with one-sided END (3/32), recurrent metastases occurred in the non-dissected side of the neck, that are assigned to initial clinical occult metastases by some authors and occur in 10-30% of the time [22,27,28,31], such as histopathological detected occult metastases after END [8,19,20,22,30] (Table 5).…”

Section: Discussioncontrasting

confidence: 56%

“…In the study of Mourouzis et al 2 out of 13 total patients with cN0-result developed cervical metastases (15%) in the course of 18 months [31]. In 8 cN0 cases with only observation in the study of Montes et al 3 patients developed late cervical metastasis (38%) in the course of 16 months [27]. In the present study, all regional recurrences developed in patients who received END.…”

Section: Discussionsupporting

confidence: 43%

“…Simental et al assumed this connection in 2 patients, where after lymph node metastases occurred, a local recurrence was diagnosed within months. Likewise, an influence of [8,19,22,23,27,[29][30][31]. Despite lack of evidence, a presentation of second primary tumors in dysplastic epithelial fields must be considered [35].…”

Section: Discussionmentioning

confidence: 99%

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Metastatic pattern in squamous cell carcinoma of the hard palate and maxillary alveolar ridge: clinical experience and review of the literature

et al. 2017

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Purpose Oral squamous cell carcinoma of the hard palate and upper alveolar ridge is rare with only few published current data regarding regional metastases after elective neck dissection or adjuvant therapy. Our aim was to investigate the incidence of initial and delayed nodal metastasis and to identify predictive factors. Methods In a retrospective cohort study, we enrolled 48 primarily surgical-treated patients from 2004 to 2014. Results Pathological initial nodal metastasis rate was 13.3% (6/45). Poor histologic grade (p = 0.048), lymphovascular infiltration (p \ 0.001) and perineural infiltration (p = 0.01) correlated with initial nodal metastasis, while advanced T-stage showed no significance (p = 0.07). Regional recurrences occurred in 14.6% of patients (7/48) and tended to emerge less frequently after therapeutic than elective neck dissection. Tumor involvement of the vestibular alveolar mucosa was a prognostic factor for developing regional recurrence (p = 0.034). Overall nodal disease rate was 27.1% (13/48). Disease-free and overall survival rates were at 73 and 93%, respectively. Conclusions The presence of poor histologic characteristics is a high risk for nodal metastasis. In patients with tumors in contact with the upper vestibular fold, the hypothesis of an impact on metastasis needs further validation.

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionsupporting

confidence: 43%

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Metastatic pattern in squamous cell carcinoma of the hard palate and maxillary alveolar ridge: clinical experience and review of the literature

et al. 2017

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1Approximately 30% of patients with cN0 disease have nodal metastasis found by pathology (pNϩ), [1][2][3][4][5] with poor prognosis, particularly if there is extracapsular spread. 6 To avoid the substantial risk of delayed detection and treatment, 7,8 elective neck dissection has been recommended for cN0 patients with a tumor invasion depth of 4 mm or greater.

9 Neck dissection provides nearly definitive information about nodal metastasis.

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confidence: 99%

“…Approximately 30% of patients with cN0 disease have nodal metastasis found by pathology (pNϩ), [1][2][3][4][5] with poor prognosis, particularly if there is extracapsular spread. 6 To avoid the substantial risk of delayed detection and treatment, 7,8 elective neck dissection has been recommended for cN0 patients with a tumor invasion depth of 4 mm or greater.…”

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Gene Expression Analysis As a Tool in Early-Stage Oral Cancer Management

Mroz

Rocco

2012

JCO

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Elective neck dissection for clinically stage N0 (cN0) disease has been called the gold standard in the management of early-stage oral squamous cell cancer (OSCC), despite advances in imaging technologies and the recent application of sentinel lymph node mapping. 1Approximately 30% of patients with cN0 disease have nodal metastasis found by pathology (pNϩ), [1][2][3][4][5] with poor prognosis, particularly if there is extracapsular spread. 6 To avoid the substantial risk of delayed detection and treatment, 7,8 elective neck dissection has been recommended for cN0 patients with a tumor invasion depth of 4 mm or greater.9 Neck dissection provides nearly definitive information about nodal metastasis. If no positive nodes are found, there is little risk of regional recurrence.5-10 Elective neck dissection alone can often represent sufficient treatment for early-stage disease, while guiding the use of adjuvant radiation and chemotherapy when indicated. Nevertheless, with approximately 70% of cN0 cases also pN0, elective neck dissection raises concern over unnecessary surgery and its associated morbidity.11 Thus, some clinicians instead recommend watchful waiting, hoping to detect and treat any nodal metastasis quickly, 2 whereas others argue that the potential therapeutic benefit of neck dissection outweighs the risk of morbidity.1 Consequently, interest in solving this clinical treatment dilemma has prompted continued investigation into novel ways to improve the management of the cN0 neck in early-stage OSCC.In the article that accompanies this editorial, van Hooff et al 12 report major advances toward a primary-tumor RNA expression signature to help in this choice. With a laboratory-made microarray, this group had previously identified genes whose expression levels in primary oral-cavity tumors were related to nodal metastasis. 13,14 They now have moved their analysis platform to a commercial microarray in a Clinical Laboratory Improvement Amendments/International Organization for Standardization-approved laboratory, finding a gene-expression signature-score cutoff in a "platform transition" cohort that provided 92% negative predictive value in cT1-T2N0 cases (ie, 92% of cases with negative expression signatures were actually metastasis free, based on pathologic evaluation of the neck dissection). They then used that signature cutoff to classify a "validation" cohort of 222 specimens from eight institutions, finding 89% negative predictive value and 86% assay sensitivity for detecting pNϩ cases. Major challenges, however, remain in incorporating these promising technical results into clinical practice.A major reason for Van Hooff et al's successful extension of earlier findings to the more clinically relevant setting of their study is the large number of diagnostic genes-696 genes, with a total of 732 microarray probe sequences-whose primary-tumor expression levels were used quantitatively. The risk of nodal metastasis for each patient was gauged by how closely each of its 732 expression values matched the correspo...

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Systematic review and meta‐analysis of cervical metastases in oral maxillary squamous cell carcinoma

et al. 2021

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Background: Management of the node-negative neck in oral maxillary squamous cell carcinoma (SCC), encompassing the hard palate and upper alveolar subsites of the oral cavity, is controversial, with no clear international consensus or recommendation regarding elective neck dissection in the absence of cervical metastases.Aim: To assess the occult metastatic rate in patients with clinically node negative oral maxillary SCC; both as an overall metastatic rate, and a comparison of patients managed with an elective neck dissection at index surgery, compared to excision of the primary with clinical observation of the neck. Methods and results:A systematic review was performed by two independent investigators for studies relating to oral maxillary SCC and analysed according to PRISMA criteria. Data were extracted from Pubmed, Ovid MEDLINE, EMBASE, and SCOPUS via relevant MeSH terms. Grey literature was searched through Google Scholar and OpenGrey. Five hundred and fifty-three articles were identified on the initial search, 483 unique articles underwent screening against eligibility criteria, and 29 studies were identified for final data extraction. Incidence of occult metastases in patients with clinically node negative oral maxillary SCC was identified either on primary elective neck dissection or on routine follow up. Meta-analyses were performed. Of 553 relevant articles identified on initial search, 29 were included for analysis. The pooled overall rate of occult metastases in patients initially presenting with clinically node-negative disease was 22.2%. There is a statistically significant effect of END on decreasing regional recurrence demonstrated in this study (RR 0.36, 95% CI 0.24, 0.59). Conclusion:The results of this systematic review and meta-analysis suggest elective neck dissection for patients presenting with hard palate or upper alveolar SCC, even in a clinically node negative neck.

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Oral maxillary squamous carcinoma: An indication for neck dissection in the clinically negative neck

Cited by 48 publications

References 27 publications

Metastatic pattern in squamous cell carcinoma of the hard palate and maxillary alveolar ridge: clinical experience and review of the literature

Metastatic pattern in squamous cell carcinoma of the hard palate and maxillary alveolar ridge: clinical experience and review of the literature

Gene Expression Analysis As a Tool in Early-Stage Oral Cancer Management

Systematic review and meta‐analysis of cervical metastases in oral maxillary squamous cell carcinoma

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