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. 2015 May-Jun;81(3):248-54.
doi: 10.1016/j.bjorl.2015.03.004. Epub 2015 Mar 30.

Oral cavity squamous cell carcinoma: factors related to occult lymph node metastasis

André Fernandes d'Alessandro  1 , Fábio Roberto Pinto  2 , Chin Shien Lin  2 , Marco Aurélio Vamondes Kulcsar  2 , Cláudio Roberto Cernea  1 , Lenine Garcia Brandão  1 , Leandro Luongo de Matos  3
Affiliations

Oral cavity squamous cell carcinoma: factors related to occult lymph node metastasis

André Fernandes d'Alessandro et al. Braz J Otorhinolaryngol. 2015 May-Jun.

Abstract
in English, Portuguese

Introduction: Elective neck dissection is recommended in cases of oral cavity squamous cell carcinoma without lymph node metastasis because of the risk of occult metastasis.

Objective: The present study aimed to evaluate predictive factors for occult lymph node metastasis in patients with oral cavity squamous cell carcinoma treated with elective neck dissection and their impact on overall and disease-free survival.

Methods: Forty surgically treated patients were retrospectively included.

Results: Ten cases (25%) had lymphatic metastasis. Of the studied variables, perineural and angiolymphatic invasion in addition to tumor thickness were statistically associated with lymph node metastasis. Only angiolymphatic invasion was identified as an independent risk factor for occult metastasis in the logistic regression (OR=39.3; p=0.002). There was no association between overall and disease-free survival with the presence of occult lymph node metastasis.

Conclusion: Metastatic disease rate was similar to that found in the literature. Perineural and angiolymphatic invasion and tumor thickness were associated with occult metastasis, but only angiolymphatic invasion showed to be an independent risk factor.

Introdução: O esvaziamento cervical eletivo é realizado de maneira sistemática nos casos de carcinoma espinocelular da cavidade oral sem linfonodos clinicamente comprometidos devido à alta incidência de metástases ocultas.

Objetivo: Avaliar pacientes com carcinoma espinocelular de cavidade oral tratados com esvaziamento cervical eletivo quanto a fatores preditivos para ocorrência de metástases ocultas e o impacto das mesmas na sobrevivência global e livre de progressão destes pacientes.

Método: Quarenta pacientes cirurgicamente tratados foram avaliados em estudo retrospectivo.

Resultados: Dez casos (25%) apresentaram metástases ocultas. Das variáveis analisadas, invasão perineural e angiolinfática e também a espessura tumoral foram estatisticamente significantes à análise univariada. Apenas a invasão angiolinfática foi fator independente de risco de metástases ocultas pela regressão logística (OR = 39,3; p = 0,002). A presença de metástase oculta não apresentou diferença estatisticamente significante em relação às taxas de sobrevivência global e livre de progressão.

Conclusão: A incidência de metástase oculta foi semelhante à literatura. A invasão perineural, angiolinfática e a espessura tumoral foram fatores associados à presença de metástase oculta, porém apenas a invasão angiolinfática apresentou-se como um fator de risco independente para ocorrência do fenômeno.

Keywords: Boca; Carcinoma; Células escamosas; Lymphatic metastasis; Metástase linfática; Mouth; Prognosis; Prognóstico; Squamous cell.

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Figures

Figure 1
Figure 1
Kaplan–Meier Curves. (A) Cumulative disease-free survival of 68.2%; (B) Cumulative overall survival of 64.1%.
Figure 2
Figure 2
Kaplan–Meier curves comparing the groups with absence and presence of occult lymph node metastasis. (A) Cumulative disease-free survival of 71.4% and 60.0%, respectively, for the absence and presence of occult lymph node metastases (p = 0.587 – log-rank test); (B) Cumulative overall survival of 80.4% and 40.0%, respectively, for the absence and presence of occult lymph node metastases (p = 0.248 – log-rank test).
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