Risk factors for distant metastasis in locoregionally controlled oral squamous cell carcinoma: a retrospective study

Abstract

The control of distant metastasis in oral squamous cell carcinoma is an important determinant of improved prognosis. The study aimed to identify risk factors for distant metastasis in patients with locoregionally controlled oral carcinoma. We identified 982 patients with oral squamous cell carcinoma treated at our hospital between January 2008 and December 2017. After excluding patients with distant metastasis at initial treatment, patients with metastasis to the oral cavity, those receiving palliative treatment, and those lacking follow-up data, 941 patients were selected. Finally, among these 941 patients, 887 with locoregionally controlled oral squamous cell carcinoma were included in the study. Among the 887 patients, 36 had confirmed distant metastasis (4.1%), and the lung was the most common site (31/36 patients, 86.1%). Multivariate analysis showed that the incidence of primary intraosseous carcinoma of the mandible, cervical lymph node metastasis at levels IV and V, and the presence of pathological extranodal extension were significant risk factors for distant metastasis. When treating patients with oral squamous cell carcinoma who are positive for the aforementioned risk factors, the possibility of developing distant metastases must be accounted for, and aggressive treatment should be planned accordingly.

Effects of Red Blood Cell Transfusions on Distant Metastases of Oral Squamous Cell Carcinomas

“…In comparison, our study did not reveal any correlations between the localization of the tumor and the occurrence of M+, but it also identified the pN stage as one of the most important risk factors. A strong correlation between nodal status and the occurrence of M+ was confirmed previously [ 35 , 36 , 37 , 38 , 40 ]. Even studies investigating head and neck squamous cell carcinoma, including carcinomas of the pharynx and larynx, confirmed this correlation [ 36 , 38 ].…”

“…Hence, RBC transfusions ( Figure 1 ) and pN stage ( Figure 2 ) proved to be independent risk factors for M+ even when adjusted for the main confounding factors. While lymph node status was already found to be an independent prognostic factor in previous studies [ 35 , 36 , 37 , 38 ], this is the first study to report RBC transfusions as a significant risk factor for M+. The hazard ratio (HR) of developing M+ is 2.42 times higher for transfused patients compared to non-transfused patients.…”

“…While there is a plethora of literature that investigates the correlation of patient-specific features regarding health and therapy with the development of M+ in patients with OSCC [ 35 , 36 , 37 , 38 , 40 , 41 ], there is no study evaluating RBC transfusions as an independent factor. A recent study identified the incidence of primary intraosseous carcinoma of the mandible and cervical lymph node status as independent risk factors for the development of M+ in OSCC patients [ 37 ]. In comparison, our study did not reveal any correlations between the localization of the tumor and the occurrence of M+, but it also identified the pN stage as one of the most important risk factors.…”

“…Even studies investigating head and neck squamous cell carcinoma, including carcinomas of the pharynx and larynx, confirmed this correlation [ 36 , 38 ]. Other authors postulated clinical lymph node status [ 35 ], extracapsular spread [ 37 , 38 , 40 ], or locoregional control [ 40 ] as independent prognostic factors and found them to be statistically significant. The important role of cervical lymph nodes in the treatment of OSCC and head and neck squamous cell carcinomas (HNSCC) could be explained by the higher amount of disseminated and circulating tumor cells due to extranodal expansion [ 41 ].…”

Risk factors for distant metastasis in oral cancer and a strategy preoperative detection

“…It might therefore be assumed that perineural invasion could also play a key role in the appearance of DM. Moreover, several studies report an association between vascular invasion and a higher risk of distant dissemination of disease (9,10,(15)(16)(17)(18)(19)(20). However, in the present study, vascular invasion was not found to be a relevant factor for the development of DM (P>0.005).…”