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. 2024 Sep;115(9):3169-3179.
doi: 10.1111/cas.16209. Epub 2024 Jul 15.

Tumor thickness as a novel risk factor for lymph node metastasis by superficial squamous cell carcinoma of head and neck

Satoshi Fujii  1   2 , Chikatoshi Katada  3 , Hidenobu Watanabe  4 , Tadakazu Shimoda  5 , Atsushi Ochiai  2 , Tetsuji Yokoyama  6 , Yasutoshi Sakamoto  7 , Koichi Kano  8 , Masaaki Ichinoe  9 , Tetsuo Nemoto  10 , Masahiro Fujita  11 , Yoko Tateishi  12 , Hitoshi Sugiura  13 , Tetuo Mikami  14 , Tomonori Yano  15 , Takakuni Kato  16 , Manabu Muto  3 , Ryuichi Hayashi  17
Affiliations

Tumor thickness as a novel risk factor for lymph node metastasis by superficial squamous cell carcinoma of head and neck

Satoshi Fujii et al. Cancer Sci. 2024 Sep.

Abstract

Narrow-band imaging combined with magnified endoscopy has enabled the detection of superficial squamous cell carcinoma of the head and neck (SSCCHN) that has been resected with minimally invasive treatment, preserving vocalization and swallowing functions. However, risk factors of lymph node metastasis (LNM) must be identified, as some patients with LNM have a poor prognosis. From an initial 599 patients with 700 lesions who underwent trans-oral surgery in 27 Japanese hospitals (a nationwide registration survey), we enrolled 541 patients with 633 SSCCHNs, as indicated by central pathological diagnoses. All pathological specimens for each patient were examined using 20 pathological factors that are thought to affect the LNM of SSCCHN. In all, 24 (4.4%) of the 568 SSCCHNs exhibited LNM, and all 24 had at least one solitary nest of epithelial neoplastic cells present in the stroma, clearly separated from the intraepithelial carcinoma. Multivariate analysis also showed that tumor thickness (p = 0.0132, RR: 7.85, 95% confidence interval [CI]: 1.54-40.02), and an INFc pattern classified as infiltrating growth (INF) with unclear boundaries between tumor and non-tumor tissues (p = 0.0003, RR: 14.47, 3.46-60.46), and tumor budding (p = 0.0019, RR: 4.35, CI: 1.72-11.01) were significantly associated with LNM. Solitary nests may be indicative of LNM. In addition, tumor thickness was revealed to be a risk factor for LNM in SSCCHNs using pT factors that do not include an invasion depth element because of the anatomical absence of the muscularis mucosae.

Keywords: lymph node metastasis; narrow‐band imaging; solitary nest; superficial squamous cell carcinoma; tumor thickness.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Solitary nests as the definition of invasion and tumor thickness. Solitary nests are denoted with arrows (A). The length of the vertical line drawn from the deepest part of the tumor to the surface layer is measured as the tumor thickness, not necessarily where the tumor is thickest (A–D). The tumor thickness of each tumor acts as a substitute marker for the invasive depth. The tumor thickness is 1190 μm.
FIGURE 2
FIGURE 2
Consort diagram of the patients in this study with superficial squamous cell carcinoma of the head and neck.
FIGURE 3
FIGURE 3
Relationship between clinicopathological features including tumor diameter, tumor thickness, intraepithelial tumor thickness and invasive depth, and lymph node metastasis.
FIGURE 4
FIGURE 4
A representative tumor of the 26 tumors with lymph node metastasis. The tumor showed an infiltrative (INFc) growth pattern. Small and trabecular carcinoma cell nests are observed in the invasive front of the tumor. Left: low magnified view, black bar represents 500 μm. Right: high magnified view in the invasive front of the tumor, black bar represents 100 μm.
FIGURE 5
FIGURE 5
Receiver operating characteristic curve analysis of tumor thickness and lymph node metastasis.
See this image and copyright information in PMC

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