Department of Oral Oncology, Kidwai Memorial Institue of Oncology, Dr. Mh Marigowda Road, Bengaluru, Karnataka-560029
Med Oral Patol Oral Cir Bucal. 2021 Jan 1;26(1):e84-e89. doi: 10.4317/medoral.24016.
The study was performed with an aim to map the pattern of metastasis of squamous cell carcinomas of buccal mucosa to various cervical lymph node levels and analyze its correlation with primary tumor size and histo-pathological grading.
254 patients with squamous cell carcinoma of the buccal mucosa treated with surgery first approach were analyzed retrospectively. The tumor size was noted from pre-operative CT Scans and were divided into early and advanced tumors. The resected specimen was studied to note the histo-pathological grading of the squamous cell carcinoma and the metastatic deposits at various lymph node levels.
Out of 254 patients (149 females, 105 males), 145 patients showed histo-pathologically proven metastatic deposits in one or more lymph nodes out of which there were 56 patients showing occult metastasis. 78/145 patients showed metastatic involvement of level IB and/or IA lymph nodes, 31 showed involvement of level II and/or I lymph nodes, 27 showed involvement of level III with or without involvement of level I and II and 9 showed metastasis to level IV and V lymph nodes with or without level I, II or III lymph nodes. Cervical lymph node metastasis had statistically significant association with tumor size with advanced tumors showing worse pattern of metastatic spread beyond level I and II lymph nodes. As the degree of differentiation of squamous cell carcinoma reduced, they were more prone for cervical metastasis with moderately and poorly differentiated squamous cell carcinoma showing higher involvement of level III, IV and V lymph nodes.
The majority of buccal mucosa cases showed metastasis to level I, II and III lymph nodes out of which level IB and/or IA was most frequently involved. Metastasis to level IV and V lymph nodes was rare and was seen especially in patients with advanced primary tumor and poor histo-pathologic differentiation.
本研究旨在描绘颊黏膜鳞状细胞癌向各颈部淋巴结水平转移的模式，并分析其与原发肿瘤大小和组织病理学分级的相关性。
回顾性分析了 254 例接受手术治疗的颊黏膜鳞状细胞癌患者。术前 CT 扫描记录肿瘤大小，并分为早期和晚期肿瘤。研究切除标本以记录鳞状细胞癌的组织病理学分级和各淋巴结水平的转移性沉积物。
在 254 例患者（149 例女性，105 例男性）中，145 例患者的一个或多个淋巴结中存在组织学证实的转移性沉积物，其中 56 例患者存在隐匿性转移。78/145 例患者的 IB 和/或 IA 水平淋巴结有转移性受累，31 例患者的 II 和/或 I 水平淋巴结有转移性受累，27 例患者的 III 水平有转移性受累，伴有或不伴有 I 和 II 水平的受累，9 例患者转移至 IV 和 V 水平淋巴结，伴有或不伴有 I、II 或 III 水平淋巴结。颈部淋巴结转移与肿瘤大小具有统计学显著相关性，晚期肿瘤的转移性扩散模式较差，超过 I 和 II 水平淋巴结。随着鳞状细胞癌分化程度的降低，它们更容易发生颈部转移，中分化和低分化鳞状细胞癌更倾向于累及 III、IV 和 V 水平淋巴结。
大多数颊黏膜病例转移至 I、II 和 III 水平淋巴结，其中最常受累的是 IB 和/或 IA 水平。IV 和 V 水平淋巴结转移罕见，尤其见于原发肿瘤晚期和组织病理学分化差的患者。
