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. 2024 Jan 24;28(1):113.
doi: 10.1007/s00784-024-05514-8.

Occult metastasis is no burden factor in oral squamous cell carcinoma patients when adhering to a standardized approach in neck dissection

Ann-Kristin Struckmeier  1   2 , Mayte Buchbender  3   4 , Tobias Moest  3   4 , Rainer Lutz  3   4 , Abbas Agaimy  4   5 , Marco Kesting  3   4
Affiliations

Occult metastasis is no burden factor in oral squamous cell carcinoma patients when adhering to a standardized approach in neck dissection

Ann-Kristin Struckmeier et al. Clin Oral Investig. .

Abstract

Objectives: Management of the neck in patients with oral squamous cell carcinoma (OSCC) is pivotal to oncologic control and survival. However, there is controversy regarding necessity of neck dissection (ND) in patients with clinically node-negative neck. We aimed to assess risk factors for occult metastasis and to explore whether the presence of occult lymph node metastases (LNMs) has an impact on recurrence and survival.

Material and methods: A retrospective cohort study was performed including patients with primary OSCC who underwent radical tumor resection and ND in a high-volume center adhering to the prevailing German guideline. The ND was performed according to a standardized approach.

Results: Four hundred twenty-one patients with primary surgically treated OSCC were included. The incidence of occult metastasis was 14.49%. A pathological T stage > 1 (multivariate analysis, odds ratio (OR) 3.958, p = 0.042) and the presence of extranodal extension in LNMs (multivariate analysis, OR 0.287, p = 0.020) were identified as independent risk factors for occult metastasis. When comparing patients with and without occult metastasis, there were no significant differences in terms of progression-free survival (log-rank, p = 0.297) and overall survival (log-rank, p = 0.320). There were no cases of ipsilateral neck recurrence. One patient developed contralateral neck metastasis; however, he initially presented with a unilateral pT1 pN0 tumor.

Conclusions: Overall, our findings suggest that conducting a standardized approach in ND should be applied in terms of management of the neck in order to maintain survival rates and to prevent neck recurrence in OSCC patients.

Clinical relevance: None of the risk factors for occult metastasis can be reliably assessed preoperatively. Although elective ND does not guarantee the complete prevention of neck recurrence, it increases the likelihood of either timely removal of micrometastases or strengthens the justification for adjuvant therapy. Consequently, this approach leads to improvements in clinical outcomes.

Keywords: Lymph node metastasis; Neck dissection; Occult metastasis; Oral squamous cell carcinoma.

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Conflict of interest statement

The authors declare no competing interests.

The authors have no financial or non-financial conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Flow chart for the algorithm of neck dissection in patients with oral squamous cell carcinoma. Abbreviations: cN0 clinically node-negative neck, LNM lymph node metastasis, MRND modified radical neck dissection, SND selective neck dissection
Fig. 2
Fig. 2
Distribution of pathological nodal staging among patients with occult metastasis
Fig. 3
Fig. 3
Kaplan–Meier curves of progression-free survival and overall survival depending on the presence of occult metastasis. There were no significant differences in terms of progression-free survival (log-rank, p = 0.297) and overall survival (log-rank, p = 0.320) between these two groups
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References

    1. Massano J, Regateiro FS, Januario G, Ferreira A. Oral squamous cell carcinoma: review of prognostic and predictive factors. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102:67–76. doi: 10.1016/j.tripleo.2005.07.038. - DOI - PubMed
    1. Ferlay J, Colombet M, Soerjomataram I, Mathers C, Parkin DM, Pineros M, Znaor A, Bray F. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer. 2019;144:1941–1953. doi: 10.1002/ijc.31937. - DOI - PubMed
    1. Moratin J, Horn D, Metzger K, Ristow O, Flechtenmacher C, Engel M, Hoffmann J, Freier K, Freudlsperger C. Squamous cell carcinoma of the mandible - patterns of metastasis and disease recurrence in dependence of localization and therapy. J Craniomaxillofac Surg. 2020;48:1158–1163. doi: 10.1016/j.jcms.2020.10.006. - DOI - PubMed
    1. Ganly I, Patel S, Shah J. Early stage squamous cell cancer of the oral tongue–clinicopathologic features affecting outcome. Cancer. 2012;118:101–111. doi: 10.1002/cncr.26229. - DOI - PubMed
    1. Crile G. III. On the technique of operations upon the head and neck. Ann Surg. 1906;44:842–850. doi: 10.1097/00000658-190612000-00003. - DOI - PMC - PubMed