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    • br Results Mouth floor invasion

    2018-11-06


    Results Mouth floor invasion and midline crossing tumors were statistically significant for the presence of pretreatment cN2c after statistical analysis (Table 1). All seven cN2c patients underwent bilateral neck dissection. Five of them were further confirmed by pathology as bilateral neck metastasis (pN2c). Another patient had contralateral neck relapse later. Of the 677 non-cN2c patients, 48 underwent prophylactic bilateral neck dissection. Post-operatively, 8 of the 48 elective bilateral neck dissection were pathologically further diagnosed to have bilateral neck Senexin B manufacturer node metastasis (pN2c). There were 13 pathologic N2c cases. After statistical analysis, midline-crossing tumors had statistically significant impact on the presence of pathologic contralateral neck lymph node metastasis (pN2c; Table 1). Contralateral neck relapse was diagnosed in 26 patients, one of whom was previously diagnosed as a case of cN2c and underwent bilateral neck dissection. Eighteen of the 26 cases underwent ipsilateral neck dissection for curative therapy, while seven had a wait-and-see policy for their neck nodes (Fig. 1). Mouth floor invasion and poor differentiation of tumor showed statistically significant impact on contralateral neck relapse for oral SCC patients who received ipsilateral neck dissection. Poorly differentiated tumor showed statistically significant impact on contralateral neck relapse (Table 2). The odds ratio was the association measurement used to evaluate metastases in accordance with each factor under study. By multivariate analysis, tumor with invasion to the mouth floor exhibited a 12.4-fold higher risk of association with cN2c, while midline-crossing tumor showed a 13.1-fold higher risk of association with cN2c (Table 2). Midline-crossing tumors exhibited a 6.0-fold higher risk of association with pN2c by multivariate analysis (Table 1). For cases with contralateral neck dissection, poorly differentiated tumors exhibited a 3.9-fold higher risk of contralateral neck relapse by multivariate analysis (Table 2). In patients with ipsilateral neck dissection, mouth floor invasion showed a 4.9-fold higher risk of contralateral neck relapse, while poorly differentiated tumors showed an 8.0-fold higher risk by multivariate analysis (Table 2).
    Discussion A review of related articles shows that the frequency of metastasis to contralateral cervical lymph nodes of oral carcinomas varies from 4% to 16.1%. The definition of contralateral neck metastasis includes the presence of initial contralateral lymph node involvement, occult contralateral neck lymph node metastasis confirmed via pathology study, and contralateral neck relapse. In this study, the frequency for contralateral neck metastasis and occult contralateral neck metastasis was 5.6% (38/683) and 4.9% (33/676), respectively. Koo et al reported a figure of 11% occult contralateral neck metastasis, and state that patients with clinically positive ipsilateral neck nodes also have a higher risk of contralateral neck occult metastasis. Kurita et al reported 14.7% contralateral neck metastasis, while Gonzalez-Garcia et al reported 9.8% ipsilateral and 4.4% contralateral neck recurrence. Lim et al reported 4% occult contralateral neck metastasis in early stage oral tongue SCC, and Koxalski et al reported 14% contralateral neck metastasis. The 5-year overall survival rate for the contralateral neck relapse group is 24.7%, while for the noncontralateral neck relapse group it is 61% (p=0.0001). Koo et al also showed lower 5-year disease-specific and overall survival rates of OSCC patients with positive contralateral neck metastasis. There are a few reports in the literature with regard to the factors involved in the risk of contralateral metastasis. Koxalski et al reported that the clinical stage, tumor crossing of the midline, and floor of mouth involvement are predictors of contralateral metastasis, and give a figure of 14% contralateral neck metastasis. Kurita et al reported that the T stage, number of ipsilateral lymph node metastasis, and histopathologic grade are independent and significant predictors of contralateral neck metastasis. Gonzalez-Garcia et al showed that histopathologic grading and peritumor inflammation are statistically significantly related to contralateral neck recurrence. Lim et al reported no survival benefits of elective contralateral neck dissection for early-stage oral tongue SCC, while Hiratsuka et al reported that the mode of carcinoma invasion, intensity of lymphocytic infiltration, degree of differentiation, number of mitotic figures, and type of growth are predictors of occult neck lymph node metastasis. Godden et al reported that tumor thickness of more than 5mm is a strong predictor for neck recurrence of OSCC, while Koo et al reported that advanced (≥T3) OSCC, midline-crossing tumor, and positive ipsilateral neck node have higher risks of contralateral occult neck metastasis.