PROGNOSIS AND MULTIVARIANT ANALYSIS OF N2c NODAL DISEASE IN ORAL CAVITY SQUAMOUS CELL CARCINOMA: A 10 YEAR STUDY IN TERTIARY CANCER CENTRE IN SOUTH INDIA.

Dr. Subbiah Shanmugham, Prof. G. Gopu, Dr. Syed Afroze Hussain, Dr. A. Jagadish Singh

Abstract


CONTEXT: Surgery plays a pivotal role in the management of advanced oral cancers. The incidence of contralateral nodal disease in oral cavity
squamous cell carcinoma is quite predictable in relation with certain variables, helping us in addressing this nodal disease. The mortality associated
with N2c disease is relatively high, hence optimising the treatment of N2c disease can have impact in the survival in certain subset of patients.
AIM: The aim is to identify the clinico-pathological factors associated with N2c nodal disease and mortality associated with the disease.
MATERIALS AND METHODS: A retrospective audit of 484 oral Squamous Cell Carcinoma (SCC) patients treated at Royapettah cancer centre,
Chennai from 2007-2017. All cases with N2c disease (39 patients) at presentation /relapsed at opposite node were analysed. The parameters
analysed were anatomical subset in oral cavity, age(</>50 yr), gender, tobacco habits, midline crossing tumors, skin/bone involvement of primary
tumor, ipsilateral nodal characteristics.
RESULTS: Mortality with N2c disease was nearly 72.5% in our series. Among the oral cancers tongue buccal mucosa and floor of mouth subsets
cancer were significantly associated with N2c disease whereas alveolus, palate were not significant. Midline crossing tumors were the single most
independent factor significantly associated with N2c disease. T3 and above tumors were also significantly associated. Ipsilateral node parameters
like pathological positivity and multiplicity were significant in determining the N2c disease, (size of 3-6cm were 19/39, multiple nodal positivity
(≥4 nodes) 4/39, pathological nodal positivity was 9/39). In our audit we found 26:13 M:F ratio. Almost all (~100%) of them had tobacco abuse
history.
CONCLUSION: N2c nodal disease is associated with mortality rate nearly equal to distant metastases in our study. By identifying the parameters
associated with development of N2c disease and initiating appropriate treatment early we can achieve better survival in certain subset of patients.


Keywords


Squamous Cell Carcinoma - SCC, Contralateral Neck node metastases – CLMM, Royapettah Scoring System - RSS Midline Crossing Tumour – MLCT, Ipsilateral Nodal Parameters - IPL, Metastases in Bilateral or Contralateral Lymph nodes none larger than 6cm in grea

Full Text:

PDF

References


The prognostic importance of midline involvement in oral tongue cancer.Lloyd S1, Yu JB, Wilson LD, Judson BL, Decker RH.

Skin involvement and ipsilateral nodal metastasis as a predictor of contralateral nodal metastasis in buccal mucosa cancers.Mair M1, Nair S1, Thiagarajan SK1, Agrawal J1, Nair D1, Chaturvedi P1.

Contralateral neck failure in lateralized oral squamous cell carcinoma.Habib M1, Murgasen J1, Gao K2, Ashford B1,3, Shannon K2, Ebrahimi A1,4,5, Clark JR1,2,5,6

[Clinicopathologic features and risk factors of bilateral cervical lymph node metastasis in head and neck squamous cell carcinoma].Di B1, Li X2, Song Q1, Liu S1, Tao Z1, Xiao S1.

Prognostic factors influencing contralateral neck lymph node metastases in oral and oropharyngeal carcinoma.Capote-Moreno A1, Naval L, Muñoz-Guerra MF, Sastre J, Rodríguez-Campo FJ.

Contralateral lymph neck node metastasis of squamous cell carcinoma of the oral cavity: a retrospective analytic study in 315 patients.González-García R1, Naval-Gías L, Rodríguez-Campo FJ, Sastre-Pérez J, Muñoz-Guerra MF, Gil-Díez Usandizaga JL.

Contralateral lymph neck node metastasis of primary squamous cell carcinoma of the tongue: a retrospective analytic study of 203 patients.González-García R1, Naval-Gías L, Sastre-Pérez J, Rodríguez-Campo FJ, Muñoz-Guerra MF, Usandizaga JL, Díaz-González FJ.

Treatment of contralateral N0 neck in early squamous cell carcinoma of the oral tongue: elective neck dissection versus observation.Lim YC1, Lee JS, Koo BS, Kim SH, Kim YH, Choi EC.

Contralateral neck recurrence of squamous cell carcinoma of oral cavity and oropharynx.Chow TL1, Chow TK, Chan TT, Yu NF, Fung SC, Lam SH.

Clinical predictors for contralateral neck lymph node metastasis from unilateral squamous cell carcinoma in the oral cavity.Kurita H1, Koike T, Narikawa JN, Sakai H, Nakatsuka A, Uehara S, Kobayashi H, Kurashina K.Factors influencing contralateral lymph node metastasis from oral carcinoma.Kowalski LP1, Bagietto R, Lara JR, Santos RL, Tagawa EK, Santos IR.

Lymph node prognostic factors in head and neck squamous cell carcinomas.Mamelle G1, Pampurik J, Luboinski B, Lancar R, Lusinchi A, Bosq J.

A review of clinical and histological parameters associated with contralateral neck metastases in oral squamous cell carcinoma. Fan S1, Tang QL, Lin YJ, Chen WL, Li JS, Huang ZQ, Yang ZH, Wang YY, Zhang DM, Wang HJ, Dias-Ribeiro E, Cai Q, Wang L.

Prognostic factors influencing contralateral neck lymph node metastases in oral and oropharyngeal carcinoma.Capote-Moreno A1, Naval L, Muñoz-Guerra MF, Sastre J, Rodríguez-Campo FJ.Attending Surgeon, Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, Madrid, Spain. anacapote@inicia.es

Factors influencing contralateral lymph node metastasis from oral carcinoma.Kowalski LP1, Bagietto R, Lara JR, Santos RL, Tagawa EK, Santos IR.1Head and Neck Surgery Department, Hospital A.C. Camargo, Fundação Antonio Prudente, São Paulo, Brazil.

Prognostic factors influencing contralateral neck lymph node metastases in oral and oropharyngeal carcinoma.Capote-Moreno A1, Naval L, Muñoz-Guerra MF, Sastre J, Rodríguez-Campo FJ.1Attending Surgeon, Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, Madrid, Spain. anacapote@inicia.es

Current Management of Advanced Resectable OralCavity Squamous Cell CarcinomaThomas J. Ow, MD•Jeffrey N. Myers, MDDepartment of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA CancerJ Clin. 2010 Sep-Oct;60(5):277-300.

Parkin DM. Global cancer statistics in the year 2000. Lancet Oncol.2001 Sep;2(9):533-43.

Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors.AJCC cancer staging manual. 7th ed. New York: Springer;2010.

Shah JP. Patterns of cervical lymph node metastasis from squamouscarcinomas of the upper aerodigestive tract. Am J Surg. 1990Oct;160(4):405-9.

Lindberg R. Distribution of cervical lymph node metastases fromsquamous cell carcinoma of the upper respiratory and digestivetracts. Cancer. 1972 Jun;29(6):1446-9.


Refbacks

  • There are currently no refbacks.