Oncopathology, Tata Medical Center, Kolkata, India.
Radiation Oncology, Tata Medical Center, Kolkata, India.
Oral Oncol. 2021 Feb;113:105115. doi: 10.1016/j.oraloncology.2020.105115. Epub 2020 Dec 16.
Nodal metastasis is an important prognostic factor in oral squamous cell carcinoma (OSCC). Detailed topographic study of metastasis can guide surgical and adjuvant radiation treatment protocols.
Retrospective analysis of distribution of nodal spread was done by auditing pathology records of 1004 patients who underwent primary surgical management at our center.
The median nodal yield was 41 (range of 9-166) nodes, per patient. Metastasis was present in 42.9% patients, of which 52.3% demonstrated extranodal extension. Reclassification by AJCC8 criteria resulted in up-staging in 35.6% patients (pN1, pN2a, pN2b, pN2c, pN3a and pN3b in 13.1%, 3.7%, 6.9%, 0.9%, 0%, 18.1% respectively). Ipsilateral levels Ib and IIa were involved in a quarter of patients each, while IIb, IV and V were involved in < 4%, 3% and 1% of patients, respectively. Contralateral nodal metastasis was present in 5.4%. Skip metastases to level IV were 2.2% and 1.2% for tongue and gingivobuccal primaries. Tongue primaries had a lower likelihood of involving level Ib, but higher of level IIa and III, compared to gingivobuccal primaries, and a lower likelihood of extranodal extension. Primary site did not influence nodal metastasis to levels IIb, IV or V, but other factors like lymphovascular invasion, pT stage and margin status had an influence.
This large series with high nodal yield, shows low level of metastasis to level IIb, IV and V, which can help modify future guidelines for extent of surgery and avoid targeted adjuvant radiation to specific levels.
淋巴结转移是口腔鳞状细胞癌（OSCC）的一个重要预后因素。对转移的详细解剖研究可以指导手术和辅助放疗方案。
通过审核中心对 1004 例患者进行的主要手术治疗的病理记录，对淋巴结扩散的分布进行回顾性分析。
每位患者的平均淋巴结检出数为 41（9-166 个）。42.9%的患者存在转移，其中 52.3%表现为淋巴结外侵犯。根据 AJCC8 标准重新分类，35.6%的患者分期升高（pN1、pN2a、pN2b、pN2c、pN3a 和 pN3b 分别为 13.1%、3.7%、6.9%、0.9%、0%、18.1%）。同侧 Ib 和 IIa 区各受累患者占四分之一，而 IIb、IV 和 V 区受累患者分别占<4%、3%和 1%。对侧淋巴结转移占 5.4%。舌和龈颊原发灶的 IV 区跳跃性转移分别占 2.2%和 1.2%。与龈颊部原发灶相比，舌原发灶更不易累及 Ib 区，但更易累及 IIa 和 III 区，且淋巴结外侵犯的可能性更小。原发灶不影响 IIb、IV 或 V 区的淋巴结转移，但其他因素如淋巴管血管侵犯、pT 分期和切缘状态等有影响。
本研究淋巴结检出率高，显示 IIb、IV 和 V 区转移水平低，有助于修改未来手术范围的指南，并避免针对特定区域的靶向辅助放疗。
