Clinicopathological predictors of extent of cervical lymph node metastases in locally advanced squamous cell carcinoma of mandibular gingivobuccal sulcus

Abstract

Introduction: Locally advanced mandibular gingivobuccal sulcus (GBS) squamous cell carcinoma (SCC) has variable extent of cervical lymph node metastasis. Tumor thickness reliably predicts cervical lymph node metastases in early oral SCC, its reliability in predicting the extent of neck-node positivity in locally advanced GBS SCC is poorly studied. Objectives: The objective of this study is to study the association of extent of neck-node metastases with gross tumor thickness (GTT), preoperative histological differentiation (HD), and presence of clinical skin infiltration (CSI) in locally advanced SCC of mandibular GBS. Methodology: Biopsy-proven patients with locally advanced SCC of mandibular GBS, underwent composite resection with neck dissection from Level V to Level I, from January 2012 to February 2016 were included in this study. The intraoperative GTT was measured, the HD of primary tumor and presence of CSI were noted. Specimens were grossed as per guidelines established by the Royal College of Pathologists. The data were analyzed using SPSS version 22, Chi-square test, and Spearman's Rank correlation test. Results: In 130 patients, with gross tumor thickness >1 cm in 64 (49%) and 1 cm, moderate-poor HD on biopsy, and presence of CSI were associated with extensive ipsilateral cervical lymph node metastases including Levels IV and V. These factors can help in predicting the extent of the neck dissection.