Small size of metastatic lymph nodes with extracapsular spread greatly impacts treatment outcomes in oral squamous cell carcinoma patients

Extracapsular spread (ECS) of metastatic lymph nodes from oral carcinoma is the most significant prognostic predictor of a poor treatment outcome. However, only a few reports on prognostic factors in ECS-positive cases have been investigated. To address this problem, a detailed examination of ECS pa...

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Bibliographic Details
Published in:International journal of oral and maxillofacial surgery 2018-07, Vol.47 (7), p.830-835
Main Authors: Michikawa, C., Izumo, T., Sumino, J., Morita, T., Ohyama, Y., Michi, Y., Uzawa, N.
Format: Article
Language:English
Subjects:
Aged
Carcinoma, Squamous Cell - pathology
Carcinoma, Squamous Cell - therapy
Dentistry
extracapsular spread
Female
Humans
lymph node
Lymphatic Metastasis - pathology
Male
metastasis
Middle Aged
Mouth Neoplasms - pathology
Mouth Neoplasms - therapy
Neoplasm Recurrence, Local - pathology
Neoplasm Recurrence, Local - therapy
oral cancer
Predictive Value of Tests
Prognosis
size
Treatment Outcome
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Summary:Extracapsular spread (ECS) of metastatic lymph nodes from oral carcinoma is the most significant prognostic predictor of a poor treatment outcome. However, only a few reports on prognostic factors in ECS-positive cases have been investigated. To address this problem, a detailed examination of ECS pathology was conducted to determine the prognostic factors of oral squamous cell carcinoma (OSCC) with ECS of metastatic lymph nodes. This study involved 63 OSCC patients with at least one pathologically metastatic node with ECS. Among the 229 metastatic lymph nodes, 149 exhibited ECS. Univariate analysis revealed that a poor outcome and recurrence were significantly associated with the number of ECS-positive nodes, density of ECS, and the minor axis of the smallest ECS-positive node. However, multivariate analysis identified only small size of ECS-positive nodes as a significant and independent factor predicting recurrence and a poor outcome. Thus, small size of ECS-positive nodes is the most important prognostic indicator for OSCC with ECS in metastatic lymph nodes. The classification of ECS status using the minor axis of ECS-positive nodes may be useful for further prediction of a poorer prognosis in OSCC cases. Standardization of ECS diagnosis and multicenter prospective studies will be required to confirm and refine these findings.
ISSN:0901-5027
1399-0020
DOI:10.1016/j.ijom.2017.12.007