The Effects of Tumor Size, Degree of Differentiation, and Depth of Invasion on the risk of Neck Node Metastasis in Squamous Cell carcinoma of the Oral Cavity

Abstract

Cervical lymph node metastasis is the most important prognostic factor in patients with head and neck carcinoma. We retrospectively analyzed the effects of three different variables-tumor size, degree of differentiation, and depth of invasion-on the risk of neck node metastasis in 50 adults who had been treated with surgery for primary squamous cell carcinoma of the oral cavity. Primary tumor depth and other pathologic features were determined by reviewing the pathology specimens. Preoperatively, 36 of the 50 patients were clinically N0; however, occult lymph node metastasis was found in 13 of these patients (36.1%). The prevalence of neck node metastasis in patients with T1/T2 and T3/T4 category tumors was 51.5 and 58.8%, respectively. The associations between the prevalence of neck node metastasis and both the degree of differentiation and the depth of invasion were statistically significant, but there was no significant association between neck node metastasis and tumor size. We conclude that the prevalence of neck lymph node metastasis in patients with squamous cell carcinoma of the oral cavity increases as the tumor depth increases and as the degree of tumor differentiation decreases from well to poor, as has been shown in previous studies. It is interesting that tumor size, which is the most important component of the TNM system, was not significantly associated with neck node involvement.

Decreased adiponectin level is associated with aggressive phenotype of tongue squamous cell carcinoma

“…Of note, although important in the TNM system, tumor size was not significantly associated with serum adiponectin level. It is likely that the rate of lymph node metastasis was not associated with increased tumor size, but rather more closely associated with the degree of differentiation in oral cancer, as described previously . Compared with paracancer, TSCC tissues showed higher adiponectin levels at an early stage, when tumors were <4 cm and without lymph node metastasis.…”

Gender differences in prognostic factors for oral cancer

“…13,30,31 Nodal metastasis is necessary for clinical TNM staging, and it is notable that worse survival is seen in those with positive nodes at diagnosis. 24,25 Anatomical site as well as regional and distant metastasis have been identified as independent prognostic factors for females.…”

AHNS Series: Do you know your guidelines? Evidence‐based management of oral cavity cancers

“…Tumor depth has been shown to be a consistently reliable indicator of occult neck metastases. [42][43][44] Fakih et al, 39 in their RCT examining long-term survival benefits to elective versus therapeutic neck dissection, discovered that patients with tumors with a depth of invasion (DOI) >4 mm were much more likely to have occult regional metastases. Vijayakumar et al 45 looked at 217 carcinomas of the tongue and similarly found that a DOI >4 mm was associated with occult metastases with a rate of 62%.…”

“…Tumor depth has been shown to be a consistently reliable indicator of occult neck metastases . Fakih et al, in their RCT examining long‐term survival benefits to elective versus therapeutic neck dissection, discovered that patients with tumors with a depth of invasion (DOI) >4 mm were much more likely to have occult regional metastases.…”