Lymph node ratio as a prognostic marker of oral tongue squamous cell carcinoma: a cohort study (original) (raw)
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Prognostic significance of lymph node density in squamous cell carcinoma of the tongue
Head & Neck, 2015
Background. Lymph node density (LND) is more useful than the TNM classification in predicting survival after surgery for many cancers. The purpose of this study was to clarify independent prognostic factors for hypopharyngeal squamous cell carcinoma (HPSCC) and broaden the staging system to improve its predictive value. Methods. The present study included 105 patients with HPSCC treated with hypophagectomy and neck dissection between 1993 and 2014. Results. The median LND in patients with HPSCC was 0.060 (range 0.026-0.620). We found a significant difference in LND values between patients with and without recurrence (0.063 vs. 0.030, respectively; p = 0.001). The cutoff value of LND for recurrence was 0.055, with a sensitivity of 68% and specificity of 71%. Cervical lymph node metastasis, advanced pathologic T stage, lymphovascular invasion, LND C0.055, and extracapsular spread had significant adverse effects on 5-year overall and disease-specific survival in a univariate analysis. Multivariate analysis confirmed a significant association between 5-year overall survival and LND C0.055 [hazard ratio (HR) 2.19; 95% confidence interval (CI) 1.06-4.51; p = 0.035] and extracapsular spread (HR 2.47; 95% CI 1.09-5.61; p = 0.030). Furthermore, LND C0.055 (HR 2.30; 95% CI 1.07-4.93; p = 0.034) and extracapsular spread (HR 2.95; 95% CI 1.20-7.29; p = 0.019) were associated with 5year, disease-specific survival. Conclusions. The median LND cutoff values C0.055 are associated with a greater risk of recurrence and survival in patients with HPSCC.
Oral oncology, 2015
Oral squamous cell carcinomas, and tongue malignancies in particular, are among the most common tumors of the oral cavity. Classification for therapeutic and prognostic purposes is routinely made using the tumor, node, metastasis (TNM) system; however, current definitions do not include tumor thickness. We therefore aimed to identify variables associated with survival, and to evaluate the correlation between tumor thickness and the occurrence of lymph node metastasis. All patients undergoing radical tumor resection for squamous cell carcinomas of the tongue between 2000 and 2012 were included. Specimens were analyzed histopathologically and co-variables were interpreted. Follow-up was performed clinically and radiologically for at least 3years according to current guidelines. We included 492 patients who had a median follow-up of 70months. Variables associated with survival (p<0.05) were age, tumor stage, N stage, UICC (Union for International Cancer Control) stage, tumor grade, ...
Can metastatic lymph node ratio (LNR) predict survival in oral cavity cancer patients?
Journal of Surgical Oncology, 2013
Objectives: To evaluate the prognostic role of the lymph node ratio (LNR; ratio of total positive nodes to total dissected nodes) in oral squamous cell carcinoma (OSCC) as compared to pN staging with an aim to provide an optimal cutoff value. Methods: 1,408 OSCC previously untreated patients who underwent treatment (surgery þ neck dissection þ adjuvant treatment). LNR sensitivity with respect to survival was calculated using receiver operating characteristic (ROC) curves and Cox regression method. LNR and TNM staging variables were subjected to multivariate analysis. Results: LNR (0.088) showed significant association with survival outcomes. For patients with LNR 0.088, the OS, DFS, local control, regional control and distant metastasis rates were 64%, 70%, and 89%; for LNR >0.088 it was 22%, 19%, and 52%, respectively (P < 0.001). On multivariate analysis LNR of 0.088 was seen to be an independent prognostic factor for 5-year regional control (p, hazard ratio [95% confidence interval]; 0.044, 2.
Oral surgery, oral medicine, oral pathology and oral radiology, 2014
This study aimed to evaluate the utility of lymph node ratio (LNR) as a potential prognostic predictor in selected patients with oral squamous cell carcinoma (OSCC). This was a retrospective study that identified 374 patients with OSCC who underwent primary surgery from 1980 to 2010. Of these patients, 148 were identified with regionally metastasized cancer. LNR was calculated as the ratio of positive nodes to the total number of nodes removed during neck dissection. Multivariate analysis was carried out. The global median LNR was 0.07. Cutoff values of LNR 0.05 and LNR 0.07 divided the patients into low- and high-risk groups. Patients with an LNR >0.05 had a hazard ratio of 3.665 for a disease-specific survival event, in comparison to LNR <0.05. The mean follow-up period was 5.25 years. Alongside established prognostic factors for predicting the outcome in patients with OSCC, the LNR appears to be another valuable prognostic factor for risk stratification.
Contemporary Clinical Trials Communications
Background: Lymph node involvement is a fundamental prognostic factor in head and neck squamous cell carcinoma (SCC). Lymph node yield (LNY), which is the number of lymph nodes retrieved after neck dissection, and lymph node ratio (LNR), which is the ratio of positive lymph nodes out of the total removed, are measurable indicators that may have the potential to be used as prognostic factors. The present study is designed to define the exact role of LNY and LNR regarding the overall and specific survival of patients affected by oral cavity and oropharyngeal SCC. It has been registered on clinicaltrials.gov database (NCT03534778). Methods: This is a multicenter study involving tertiary care referral centers in Europe and North America. Patients affected by oral cavity, HPV+ and HPVoropharyngeal SCC undergoing neck dissection will be consecutively enrolled and followed-up for up to 5 years. Patients and disease characteristic will be properly recorded and centrally analyzed. The primary end-point is to define reliable cut off-values for LNY and LNR which may serve as prognosticators of survival. This will be achieved through the use of ROC curves. Secondary outcomes will be the Overall survival (OS), Disease Specific Survival (DSS), and Progression Free Survival Hazard Ratios (HR) at 2-, 3-and 5 years, which will be evaluated through the Kaplan-Meier method and the difference in survival attested by the log-rank test. Univariate and multivariate analysis will be performed to understand the association of various outcomes with LNY and LNR.
Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 2014
word count for the abstract: 150; complete manuscript word count: 2863; number of references: 49; number of figures: 4; number of tables: 6; number of supplementary elements: 0. ABSTRACT Objective. The aim of the study was to compare the thickness of primary tumors with the frequency of nodal metastases and survival in patients surgically treated for T1/T2N0 oral tongue squamous cell carcinoma (SCC). Study design. This is a retrospective longitudinal study with 74 patients. Results. None of the patients with a TT ≤7 mm presented with nodal metastasis, while 25 of the cases with a TT >7 mm (51.0%) developed metastases (P<0.0001). The multivariate analysis showed that TT >7 mm was a risk factor for occult nodal metastasis (OR=8.7; P=0.002) and a diagnostic test with 81.9% accuracy. TT >10 mm was also a predictive factor of worse diseasefree survival in these patients (HR=12.2; P=0.003). Conclusion. Tumor
Head & Neck, 2014
Background-Although existing literature provides surgical recommendations for treating occult disease (cN0) in early stage oral cavity squamous cell carcinoma, a focus on late stage OCSCC is less pervasive. Methods-The records of 162 late stage OCSCC pN0 individuals that underwent primary neck dissections were reviewed. Lymph node yield (LNY) as a prognosticator was examined. Results-Despite being staged pN0, patients that had a higher LNY had an improved regional/ distant control rates, DFS, DSS, and OS. LNY consistently outperformed all other standard variables as being the single best prognostic factor with a tight risk ratio range (RR = 0.95-0.98) even when correcting for the number of lymph nodes examined. Conclusion-The results of this study showed that lower regional recurrence rates and improved survival outcomes were seen as lymph node yield increased for advanced T-stage OCSCC pN0. This suggests that increasing lymph node yield with an extended cervical lymphadenectomy may result in lower recurrence rates and improved survival outcomes for this advanced stage group.
Predictors of prognosis for squamous cell carcinoma of oral tongue
Journal of Surgical Oncology, 2014
Background and Objectives: Certain tumor-related factors like thickness increases the risk of nodal metastasis and may affect survival in patients with oral tongue cancers. The objective of this study is to identify those tumor-related prognostic predictors that can potentially influence decision for adjuvant radiotherapy. Methods: A retrospective review of all patients with oral tongue cancers treated primarily by surgery at Tata Memorial Hospital between January 2007 and June 2010. The demographic and commonly reported histopathological features were analyzed for their influence on disease free and overall survival. Results: Five hundred eighty-six patients were eligible for the study, of which 416 were males and 117 were females. Follow-up details were available for 498 (85%) patients with a median follow-up of 18 months and mean follow-up of 22 months. There were 302 patients who were alive and disease free at the last follow-up. This group had a mean follow-up of 27 months and median follow-up of 27.5 months. Disease recurrences during follow-up were observed in 184 (31%) patients. Sixty-one patients died subsequently. Perineural invasion significantly affected disease free survival (DFS). A tumor thickness of more than 11 mm significantly affected the overall survival (OS). Conclusion: Other than nodal metastasis, tumor-related factors like thickness and perineural invasion are adverse prognostic factors and can influence survival. These patients, especially in case of early stage cancers, may potentially benefit from postoperative adjuvant radiotherapy. Level of Evidence: 2b.