Level V Metastases in Node-Positive Oral Squamous Cell Carcinoma: Beyond Level IIA and III.
Surgical management of level V in clinically node positive (cN+) oral squamous cell carcinomas (OSCCs) is controversial. The objectives of the study were to identify predictors of level V metastases in cN+ OSCC.
This retrospective study is based on institutional data of operated cN+ OSCC between April 2018 and December 2022. Clinical and pathological parameters were subjected to univariate analysis. Significant parameters in univariate analysis were further subjected to multivariate analysis. A p value of less than 0.05 was considered statistically significant.
None of cN1 or pN1 patients had a level V metastasis. No skip metastasis to level-V was noticed. Total number of positive lymph nodes, lymph node ratio (LNR), extranodal extension, pN classification, and the presence of level II and III metastases were found to be significant predictors for level V metastases. The post hoc analysis suggested that ≥5 positive nodes, LNR >0.1, and pN3 status were independent risk factors for level V metastases.
Selective neck dissection for N+ OSCC is feasible in the N1 neck, preferably where nodal metastases is limited to level-I only. Patients with a bulky nodal disease, particularly those with N3 neck, ≥5 positive nodes, ENE, and metastatic lymph nodes in levels II and III should be offered comprehensive neck dissection.
Surgical management of level V in clinically node positive (cN+) oral squamous cell carcinomas (OSCCs) is controversial. The objectives of the study were to identify predictors of level V metastases in cN+ OSCC.
This retrospective study is based on institutional data of operated cN+ OSCC between April 2018 and December 2022. Clinical and pathological parameters were subjected to univariate analysis. Significant parameters in univariate analysis were further subjected to multivariate analysis. A p value of less than 0.05 was considered statistically significant.
None of cN1 or pN1 patients had a level V metastasis. No skip metastasis to level-V was noticed. Total number of positive lymph nodes, lymph node ratio (LNR), extranodal extension, pN classification, and the presence of level II and III metastases were found to be significant predictors for level V metastases. The post hoc analysis suggested that ≥5 positive nodes, LNR >0.1, and pN3 status were independent risk factors for level V metastases.
Selective neck dissection for N+ OSCC is feasible in the N1 neck, preferably where nodal metastases is limited to level-I only. Patients with a bulky nodal disease, particularly those with N3 neck, ≥5 positive nodes, ENE, and metastatic lymph nodes in levels II and III should be offered comprehensive neck dissection.
Majumdar KS
，Kailey VS
，Varshney A
，Abhinav T
，Panuganti A
，Usmani SA
，Kaul P
，Maharaj DD
，Singh A
，Moideen A
，Prasath R
，Ravichandran N
，Devi NS
，Bhardwaj A
，Priya M
，Malhotra M
... -
《-》
Prognostic significance of preoperative Naples prognostic score for disease-free and overall survival in oral cavity squamous cell carcinoma post-surgery.
Oral cavity squamous cell carcinoma (OCSCC) is a common malignancy with high morbidity and mortality. This research seeks to assess the correlation between Naples Prognostic Score (NPS) and survival outcomes in patients with OCSCC who are receiving surgical treatment, highlighting its potential as a prognostic tool for predicting patient outcomes.
This retrospective study included 589 OCSCC patients from two large regional medical centers in central China, treated between February 2008 and September 2019. Inclusion criteria mandated confirmed OCSCC diagnosis, age ≥ 18 years, and radical surgery, while patients with distant metastasis, multiple tumors, or insufficient data were excluded. Data on 29 clinicopathological variables, including demographic details, tumor characteristics, and nutritional/inflammatory markers, were collected. The statistical approach included both univariate and multivariate Cox regression models to determine factors associated with disease-free survival (DFS) and overall survival (OS). Additionally, Kaplan-Meier survival analysis was employed to evaluate the effect of adjuvant radiotherapy on survival in various NPS subgroups.
Surgical margin status, ENE, NPS, age-adjusted Charlson comorbidity index (ACCI), and American Joint Committee on Cancer (AJCC) stage were identified as independent prognostic factors for DFS. Similarly, Eastern Cooperative Oncology Group Performance Status (ECOG PS), surgical margin status, extranodal extension (ENE), NPS, ACCI, and AJCC stage were found to be independent prognostic factors for OS. A higher NPS was associated with a poorer prognosis. In AJCC stage III-IVb patients with NPS 1-2, adjuvant radiotherapy significantly improved both DFS and OS. Likewise, in AJCC stage III-IVb patients with NPS 3-4, adjuvant radiotherapy was associated with better DFS and OS outcomes. However, no significant impact of adjuvant radiotherapy was observed in patients with AJCC stage I-II or in those with NPS 0, regardless of stage. This underscores the importance of NPS in stratifying patients for adjuvant therapy.
The Naples Prognostic Score is a beneficial prognostic indicator for survival in OCSCC patients. Its integration into clinical practice may assist in risk stratification and treatment decision-making, particularly for those undergoing adjuvant radiotherapy.
Xu XL
，Wu CC
，Cheng H
《BMC CANCER》
Treatment outcomes of 73 cases of external auditory canal squamous cell carcinoma: A single-center six-year analysis in Japan.
External auditory canal cancer (EAC) is a rare type among head and neck cancers, predominantly composed of squamous cell carcinoma (SCC) pathologically. Various comprehensive treatments including surgery, radiation therapy, and chemotherapy are conducted in many facilities for squamous cell carcinoma of the external auditory canal. However, due to its rarity, there is no established standard treatment. This study aimed to report the treatment outcomes at our single facility and prognostic factors post-surgery for EAC-SCC.
We conducted a retrospective analysis of 73 cases of EAC-SCC, which underwent initial treatment at our facility from July 2015 to November 2022. We utilized the modified Pittsburgh classification for TNM and staging.
There were 37 male and 36 female cases, with a median age of 65 (ranging from 40 to 93). T1: 32 cases, T2: 5 cases, T3: 14 cases, T4: 10 cases. Stage Ⅰ: 28 cases, stage Ⅱ: 5 cases, stage Ⅲ: 12 cases, stage Ⅳ: 16 cases. The median follow-up period was 23.8 months (ranging from 2.8 to 93.6 months). There were 61 cases in the surgery group and 12 cases in the chemoradiotherapy (CRT) group. In survival analysis, the overall 3-year recurrence-free survival (RFS) rate was 81.9 %, and the 3-year disease-specific survival (DSS) rate was 89.1 %. For stage III/IV advanced cancers, the 3-year RFS rate was 78.3 % and DSS rate was 79.1 % in the surgery group, and in the CRT group, they were 66.7 % and 91.7 %, respectively. For T4 cases, the 3-year RFS rate was 58.3 % and DSS rate was 61.0 % in the surgery group, and in the primary CRT group, they were 75.0 % and 87.5 %, respectively. While there were no significant differences in treatment outcomes between the surgery and CRT groups overall, there was a trend suggesting better outcomes in the CRT group for T4 cases. In advanced cases (Stage III/IV, T3/4), younger females tended to be treated with CRT. Positive resection margins (HR: 11.97, 95 % CI: 1.80-79.70, p = 0.010) revealed to be a significant prognostic factor based on RFS.
We reported the treatment outcomes at a single facility and post-surgery prognostic factors. The treatment outcomes at our facility are comparable to other institutions, and in advanced cancers, the CRT group showed a tendency for better treatment outcomes. Post-surgery prognostic factor was positive resection margins.
Ooka T
，Ariizumi Y
，Asakage T
，Tsutsumi T
... -
《-》
ResearchGate
(全网免费下载)
钛学术
(全网免费下载)
