Srinivasan Samyukta, Balasubramaniam Arthi
Department of Oral Pathology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India.
Department of Public Health Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India.
J Oral Maxillofac Pathol. 2024 Apr-Jun;28(2):261-267. doi: 10.4103/jomfp.jomfp_380_23. Epub 2024 Jul 11.
Squamous cell carcinoma (SCC) represents about 90% of all oral malignancies. The study aimed to assess the involvement of the submandibular salivary gland (SMG) in oral SCC (OSCC) patients and the need for SMG excision.
Demographics, clinical information and staging of the 210 patients undergoing surgery for OSCC were obtained from the department records. The histopathological slides were retrospectively reviewed. The nodal status was also verified with the histopathology reports. Frequency distribution, Chi-square association, ordinal logistic regression analysis and Kaplan-Meier analysis were performed.
SMG was excised in 171 patients. Five patients had SMG involvement. Buccal mucosa (BM) and gingivobuccal sulcus had a greater risk of level IB metastases ( < 0.01). Pattern 3 and pattern 4 of invasion had a higher risk of level IB metastases ( = 0.04). Depth of invasion (DOI) >4 mm was associated with level IB lymph node (LN) involvement ( = 0.0001). DOI >4 mm to 8 mm had 3.7 times the risk and a DOI >8 mm to 12 mm had 5 times the risk of level IB metastases. Pattern of invasion (POI), tumour budding and DOI >4 mm were significant prognosticators for patient survival.
Histologically, patients may be categorised as 'high risk': those with an increased risk of level IB LN involvement and 'low risk': those at low risk for level IB involvement with the help of POI, tumour budding and DOI as risk factors. In low-risk patients, SMG may be spared and the level IB LNs are dissected. High-risk patients may be chosen as candidates for SMG transfer or excision based on the extent of LN involvement.
鳞状细胞癌（SCC）约占所有口腔恶性肿瘤的90%。本研究旨在评估口腔鳞状细胞癌（OSCC）患者下颌下唾液腺（SMG）的受累情况以及切除SMG的必要性。
从科室记录中获取210例行OSCC手术患者的人口统计学、临床信息和分期。对组织病理学切片进行回顾性分析。淋巴结状态也通过组织病理学报告进行核实。进行频率分布、卡方关联分析、有序逻辑回归分析和Kaplan-Meier分析。
171例患者切除了SMG。5例患者的SMG受累。颊黏膜（BM）和牙龈颊沟发生ⅠB级转移的风险更高（<0.01）。浸润模式3和模式4发生ⅠB级转移的风险更高（=0.04）。浸润深度（DOI）>4 mm与ⅠB级淋巴结（LN）受累相关（=0.0001）。DOI>4 mm至8 mm发生ⅠB级转移的风险是前者的3.7倍，DOI>8 mm至12 mm发生ⅠB级转移的风险是前者的5倍。浸润模式（POI）、肿瘤芽生和DOI>4 mm是患者生存的重要预后指标。
从组织学角度看，患者可分为“高风险”：即ⅠB级LN受累风险增加者，以及“低风险”：即借助POI、肿瘤芽生和DOI作为风险因素，ⅠB级受累风险较低者。在低风险患者中，可保留SMG并清扫ⅠB级LN。根据LN受累程度，高风险患者可被选为SMG转移或切除的候选者。
