Clinicopathological parameters affecting nodal yields in patients with oral squamous cell carcinoma receiving selective neck dissection

Abstract

Introduction: Nodal yield has been demonstrated as a very promising marker for the prognostic outcome of patients with oral squamous cell carcinoma. However, studies on the importance of clinicopathological factors affecting the number of resected lymph nodes are rare, especially for patients without pathologically proven cervical lymph nodes.

Material and methods: Retrospective chart review of 264 patients with treatment naive oral squamous cell carcinoma and histopathologically proven negative cervical lymph node status, who received selective neck dissection of levels I-III/IV. Exclusion criteria were neoadjuvant chemoradiotherapy, comprehensive or bilateral neck dissection, T4b classification, perioperative death, unresectable disease, synchronous malignancy, follow-up <3 months and inadequate information to correctly determine nodal yield. Statistical analysis was performed by using univariate and multivariate analysis.

Results: The mean nodal yield was 22.31 with a standard deviation of 16.01 and a mean number of 17 nodes. Gender (p = 0.018), age (p = 0.03), tumor classification (p < 0.001) and perineural invasion (p = 0.012) were significantly associated with nodal yield. Multivariate analysis indicated T-classification (p = 0.049) and age (p = 0.020) as independent factors. Nodal yield was significantly associated with locoregional recurrence (p = 0.041; Cutoff value = 17).

Conclusion: Advanced age and T-classification independently affect lymph node yields in patients with oral squamous cell carcinoma. Hence, they have to be considered for interpretation of both nodal yield and recommended minimum lymph node counts. Furthermore, resection of more than 17 lymph nodes is associated with a significantly lower risk of locoregional recurrence.

Keywords: Age; Clinicopathological; Nodal yield; T Classification.