Clinicopathological Parameters Predicting Nodal Metastasis in Head and Neck Squamous Cell Carcinoma.

Abstract

Introduction Squamous cell carcinoma (SCC) is the most common type of malignancy of the head and neck region arising from the mucosal epithelium of the oral cavity and oropharynx. It is a multifactorial disease with a high rate of mortality. Lymph node metastasis is an important prognostic parameter associated with adverse prognosis. Thisstudy was conducted to establish a relationship between various clinicopathological characteristics and nodal metastasis in head and neck squamous cell carcinoma (HNSCC). Methods This retrospective study was conducted at Liaquat National Hospital, Karachi, Pakistan. A total of 306biopsy-proven cases of HNSCCwere included in the study. Clinical data, which included age, sex, and site ofthelesion, were obtained from the clinical referral forms. Resectionsof the lesions were performed, and thespecimenscollected were sent to thelaboratoryfor histological evaluation. The histologicalsubtype,perineural invasion(PNI), depth of invasion (DOI), nodal metastasis, and extranodal extension were assessed, and the association of clinicopathological parameters with nodal metastasis was sought. Results The mean age at diagnosiswas 50.26 ± 12.86 years withafemale predominance(55.27%), and the meantumor size was 3.37 ± 1.75 cm. The mean DOI was 1.08 ± 0.67 cm. The most commonsite of tumor was found to betheoral cavity (68.6%), followed bythetongue (24.2%). KeratinizingSCC(59.5%)was found to be the most prevalent histological subtype.At the time of diagnosis, the majority of thetumors were grade 2 (62.4%). PNI was present in 12.1% of the cases.Nodal metastasis was present in 44.8%, andextranodal extension was present in 17% of the cases.A significant association of nodal metastasis was noted with age, gender, tumor site, tumor size, and DOI. Male patients with HNSCC showed a higher frequency of nodal metastasis than female patients. Patients between the ages of 31 and 50 years with a tumor size ofabove 4 cm and a DOI of more than1 cm had a higher frequency of nodal metastasis. Similarly, tumors arising in the oral cavity and the keratinizing subtype were more likely to possess nodal metastasis. Conclusion We found that HNSCCs weremore prevalent among the female population, with the most common site being the oral cavity. Nodal metastasis was significantly associated with the keratinizing subtype of SCC, oral cavity location, male gender, and middle age group. Similarly, the tumor size and DOI were important predictors of nodal metastasis in HNSCC in our study.