Cervical lymph node metastasis in squamous cell carcinoma of the buccal mucosa: a retrospective study on pattern of involvement and clinical analysis.

BACKGROUND The study was performed with an aim to map the pattern of metastasis of squamous cell carcinomas of buccal mucosa to various cervical lymph node levels and analyze its correlation with primary tumor size and histo-pathological grading. MATERIAL AND METHODS 254 patients with squamous cell carcinoma of the buccal mucosa treated with surgery first approach were analyzed retrospectively. The tumor size was noted from pre-operative CT Scans and were divided into early and advanced tumors. The resected specimen was studied to note the histo-pathological grading of the squamous cell carcinoma and the metastatic deposits at various lymph node levels. RESULTS Out of 254 patients (149 females, 105 males), 145 patients showed histo-pathologically proven metastatic deposits in one or more lymph nodes out of which there were 56 patients showing occult metastasis. 78/145 patients showed metastatic involvement of level IB and/or IA lymph nodes, 31 showed involvement of level II and/or I lymph nodes, 27 showed involvement of level III with or without involvement of level I and II and 9 showed metastasis to level IV and V lymph nodes with or without level I, II or III lymph nodes. Cervical lymph node metastasis had statistically significant association with tumor size with advanced tumors showing worse pattern of metastatic spread beyond level I and II lymph nodes. As the degree of differentiation of squamous cell carcinoma reduced, they were more prone for cervical metastasis with moderately and poorly differentiated squamous cell carcinoma showing higher involvement of level III, IV and V lymph nodes. CONCLUSIONS The majority of buccal mucosa cases showed metastasis to level I, II and III lymph nodes out of which level IB and/or IA was most frequently involved. Metastasis to level IV and V lymph nodes was rare and was seen especially in patients with advanced primary tumor and poor histo-pathologic differentiation.

[1]  Aanchal Jain,et al.  Squamous cell carcinoma of buccal mucosa: An analysis of prognostic factors , 2018, South Asian Journal of Cancer.

[2]  L. Satyanarayana,et al.  Oral cancer statistics in India on the basis of first report of 29 population-based cancer registries , 2018, Journal of oral and maxillofacial pathology : JOMFP.

[3]  William A. Critchlow,et al.  Shrinkage in oral squamous cell carcinoma: An analysis of tumor and margin measurements in vivo, post-resection, and post-formalin fixation. , 2017, American journal of otolaryngology.

[4]  P. Chaturvedi,et al.  Oral squamous cell carcinoma associated with oral submucous fibrosis have better oncologic outcome than those without. , 2017, Oral surgery, oral medicine, oral pathology and oral radiology.

[5]  R. Semrau.  The Role of Radiotherapy in the Definitive and Postoperative Treatment of Advanced Head and Neck Cancer , 2017, Oncology Research and Treatment.

[6]  A. Starzyńska,et al.  Contemporary Diagnostic Imaging of Oral Squamous Cell Carcinoma – A Review of Literature , 2017, Polish journal of radiology.

[7]  T. Roques,et al.  Management of neck metastases in head and neck cancer: United Kingdom National Multidisciplinary Guidelines , 2016, The Journal of Laryngology & Otology.

[8]  Liang Cheng,et al.  Correcting the Shrinkage Effects of Formalin Fixation and Tissue Processing for Renal Tumors: toward Standardization of Pathological Reporting of Tumor Size , 2015, Journal of Cancer.

[9]  Michelle D. Williams,et al.  Prognostic biological features in neck dissection specimens , 2013, European Archives of Oto-Rhino-Laryngology.

[10]  J. Werner,et al.  Current advances in diagnosis and surgical treatment of lymph node metastasis in head and neck cancer , 2012, GMS current topics in otorhinolaryngology, head and neck surgery.

[11]  D. Ribeiro,et al.  Metastasis from oral cancer: an overview. , 2012, Cancer genomics & proteomics.

[12]  L. Queiroz,et al.  Analysis of inflammatory infiltrate, perineural invasion, and risk score can indicate concurrent metastasis in squamous cell carcinoma of the tongue. , 2012, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[13]  Subhashis Das,et al.  Cancer profile in Kolar: a ten years study. , 2010 .

[14]  R. Gilbert,et al.  Metastases to level IIb in squamous cell carcinoma of the oral cavity: A systematic review and meta‐analysis , 2009, Head & neck.

[15]  J. Woolgar,et al.  Histopathological prognosticators in oral and oropharyngeal squamous cell carcinoma. , 2006, Oral oncology.

[16]  C. Borel,et al.  Prognostic indicators for survival in head and neck squamous cell carcinomas: Analysis of a series of 621 cases , 2005, Head & neck.

[17]  R. Shiri,et al.  Oral cancers in Mumbai, India: a fifteen years perspective with respect to incidence trend and cumulative risk. , 2004, Asian Pacific journal of cancer prevention : APJCP.

[18]  S. Rogers,et al.  Survival and patterns of recurrence in 200 oral cancer patients treated by radical surgery and neck dissection. , 1999, Oral oncology.

[19]  J. Shah,et al.  Patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract. , 1990, American journal of surgery.

[20]  A. Singla,et al.  Changing Trends in oral cancer - a global scenario. , 2016, Nepal journal of epidemiology.

[21]  A. Jemal,et al.  Global cancer statistics , 2011, CA: a cancer journal for clinicians.