Sudhakar G V S, Das Ashok, Ranjan Kunal, Kataki A C
Department of Head and Neck Oncology, Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, India.
J Maxillofac Oral Surg. 2022 Jun;21(2):350-357. doi: 10.1007/s12663-022-01685-7. Epub 2022 Jan 18.
Head and neck cancer represents 5-10% of all malignancies. Squamous cell carcinoma (SCC) of the oral cavity represents about 2% of overall malignant neoplasms and 47% of the head and neck region Squamous cell carcinoma of tongue has a peculiar behavior of occult and skips metastasis to regional lymph nodes. It occasionally occurs along with floor of the mouth. The purpose of this study is to evaluate the significance of correlation between, depth of invasion of the primary tumor, its proximity with the neurovascular bundle and subsequent perineural invasion and cervical lymph node metastasis in squamous cell carcinoma tongue and floor of the mouth and the sites involving both.
A total of 108 patients with carcinoma tongue (59), floor of the mouth (20) and involving both together (29) who underwent treatment during January 2015 to June 2017 that were followed up until December 2019 were assessed. Out of 108 patients that were included in the study, 71 patients underwent primary surgery and 37 patients were inoperable (tongue-17, floor of the mouth-9 and involving both together-11).
Perineural invasion was seen in 15 cases of pT1-2 where depth of invasion was less than 1 cm and in 28 cases of pT3-4 where depth of invasion was more than 1cm (-0.075). Skip metastasis was accounted for 61.9% overall.
The triad of perineural invasion, depth of invasion and tumor size is interrelated and was responsible for cervical lymph node metastasis and prognosis of the disease. Obtaining clear deep margins of the tumor from the mucosal margin and removal of lympho-fatty tissue at the floor of the mouth is an important aspect which gives the indication about prognostic factors like depth of invasion, tumor size, cervical nodal metastasis and recurrence of the disease. High-grade tumors (T3-4), depth of invasion of tumor at 1 cm or > 1 cm, increase the propensity of perineural invasion highly.
头颈癌占所有恶性肿瘤的5%-10%。口腔鳞状细胞癌（SCC）约占全部恶性肿瘤的2%，占头颈区域恶性肿瘤的47%。舌鳞状细胞癌具有隐匿性和跳跃性转移至区域淋巴结的特殊行为。它偶尔与口底癌同时发生。本研究的目的是评估舌和口底鳞状细胞癌以及累及两者的部位中，原发肿瘤的浸润深度、其与神经血管束的接近程度以及随后的神经周围浸润与颈部淋巴结转移之间相关性的意义。
评估了2015年1月至2017年6月期间接受治疗并随访至2019年12月的108例舌癌（59例）、口底癌（20例）以及累及两者（29例）的患者。在纳入研究的108例患者中，71例接受了一期手术，37例无法手术（舌癌-17例，口底癌-9例，累及两者-11例）。
在浸润深度小于1cm的15例pT1-2病例和浸润深度大于1cm的28例pT3-4病例中可见神经周围浸润（-0.075）。总体跳跃性转移占61.9%。
神经周围浸润、浸润深度和肿瘤大小三者相互关联，是颈部淋巴结转移和疾病预后的原因。从黏膜边缘获得肿瘤清晰的深部切缘并切除口底的淋巴脂肪组织是一个重要方面，它能提示诸如浸润深度、肿瘤大小、颈部淋巴结转移和疾病复发等预后因素。高级别肿瘤（T3-4）、肿瘤浸润深度为1cm或>1cm，会显著增加神经周围浸润的倾向。
