Lee Oh Hyeong, Cho Uiju, An Jae Seong, Cho Jung-Hae
Clinical Fellow, Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Clinical Assistant Professor, Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
J Oral Maxillofac Surg. 2022 Mar;80(3):553-558. doi: 10.1016/j.joms.2021.11.003. Epub 2021 Nov 11.
The lingual lymph node (LLN) located on the internal surface of mylohyoid muscle is not currently included in oral cavity cancer surgery or conventional neck dissection. We investigated the risk factors for LLN metastasis and evaluated its oncologic significance in patients with oral tongue and floor of mouth squamous cell carcinoma.
Adult patients (≥20 years) undergoing upfront surgery and LLN dissection for oral tongue and floor of mouth squamous cell carcinoma between 2009 and 2018 were retrospectively analyzed. Patients who had relapsed after previous treatment or had neoadjuvant chemotherapy or had not undergone surgery were excluded. Association between clinicopathological risk factors (age, gender, tumor differentiation, stage, lymphatic invasion, perineural invasion, vascular invasion, metastatic lymph node ratio, and extranodal extension) and LLN metastasis was evaluated using logistic regression analysis. Disease-free survival in accordance with LLN metastasis was evaluated by the Kaplan-Meier method.
A total of 51 patients were included, and LLN metastasis was found in 9 patients (17.6%). LLN metastasis was significantly associated with advanced nodal stage, poor tumor differentiation, and vascular invasion. Cox proportional-hazards regression models showed that LLN metastasis was associated with an 8.0-fold higher risk of mortality than the absence of LLN metastasis. Patients with LLN metastasis had significantly worse 5-year disease-free survival rate than those without metastasis (22.2% vs 85.7%; P < .001).
This study suggests that LLN metastasis is a poor prognostic factor in patients with oral tongue and floor of mouth squamous cell carcinoma. The sublingual space should be carefully evaluated preoperatively and intraoperatively.
位于下颌舌骨肌内表面的舌淋巴结（LLN）目前未纳入口腔癌手术或传统颈部清扫术中。我们研究了舌淋巴结转移的危险因素，并评估了其在口腔舌部和口底鳞状细胞癌患者中的肿瘤学意义。
回顾性分析了2009年至2018年间因口腔舌部和口底鳞状细胞癌接受初次手术及舌淋巴结清扫的成年患者（≥20岁）。排除既往治疗后复发、接受过新辅助化疗或未接受手术的患者。采用逻辑回归分析评估临床病理危险因素（年龄、性别、肿瘤分化程度、分期、淋巴侵犯、神经周围侵犯、血管侵犯、转移淋巴结比例和结外扩展）与舌淋巴结转移之间的关联。采用Kaplan-Meier法评估根据舌淋巴结转移情况的无病生存率。
共纳入51例患者，其中9例（17.6%）发现有舌淋巴结转移。舌淋巴结转移与晚期淋巴结分期、肿瘤分化差和血管侵犯显著相关。Cox比例风险回归模型显示，与无舌淋巴结转移相比，舌淋巴结转移患者的死亡风险高8.0倍。有舌淋巴结转移的患者5年无病生存率明显低于无转移患者（22.2%对85.7%；P <.001）。
本研究表明，舌淋巴结转移是口腔舌部和口底鳞状细胞癌患者预后不良的因素。术前和术中应仔细评估舌下间隙。
