Abstract
Objective: Accurate predictors for occult metastasis in cT1-2N0 tongue squamous cell carcinoma (SCC) remains scarce, the main goal in current study was to evaluate whether there is significant association between lingual lymph node (LLN) metastasis and occult lymph node metastasis as well as whether there is prognostic value of LLN metastasis in early stage tongue SCC.Methods: Patients with surgically treated primary cT1-2N0 tongue SCC were prospectively enrolled from January 2010 to December 2018. LLNs were dissected independently for pathologic analysis. The main study endpoints were locoregional control survival (LRC) and disease-specific survival (DSS). The Chi-square test and multivariate regression analysis were used to assess the predictors for occult metastasis. The Kaplan-Meier approach and Cox model were used to analyze the potential prognostic factors.Results: A total of 317 patients were enrolled for analysis. Eighty-eight patients had occult metastasis with a prevalence of 27.8%. LLNs presented in 89 patients, in which 43 patients had LLN metastasis. In the 43 patients with positive LLNs, 20 patients had occult metastasis, in 274 patients with negative LLNs or no LLNs, 68 patients had occult metastasis, the difference was significant (p = 0.012). Further multivariate regression analysis confirmed the independence of LLN metastasis in predicting the occult metastasis. In patients without LLNs, the 5-year LRC rate was 79%, in patients with negative LLNs, the 5-year LRC rate was 78%, in patients with positive LLNs, the 5-year LRC rate was 62%, the difference was significant (p = 0.024). In patients without LLNs, the 5-year DSS rate was 84%, in patients with negative LLNs, the 5-year DSS rate was 74%, in patients with positive LLNs, the 5-year DSS rate was 51%, the difference was significant (p < 0.001), further Cox model confirmed the independence of LLN metastasis in affecting the LRC and DSS.Conclusions: LLN metastasis is significantly associated with occult neck lymph node metastasis, and decrease the LRC and DSS in early stage tongue SCC.
Highlights
Tongue squamous cell carcinoma (SCC) is the most common oral cavity malignancy [1, 2], its prognosis has not improved significantly despite advances in diagnosis and treatment, neck lymph node metastasis is one of the most important prognostic factors [3, 4], but these positive lymph nodes are usually occult or subclinical at the initial treatment in early stage tongue SCC
Lingual lymph nodes (LLNs) presented in 89 patients, in which 43 patients had LLN metastasis
Further multivariate regression analysis confirmed the independence of LLN metastasis in predicting the occult metastasis
Summary
Tongue squamous cell carcinoma (SCC) is the most common oral cavity malignancy [1, 2], its prognosis has not improved significantly despite advances in diagnosis and treatment, neck lymph node metastasis is one of the most important prognostic factors [3, 4], but these positive lymph nodes are usually occult or subclinical at the initial treatment in early stage tongue SCC. Owing to a wide range of occult metastasis rate [5, 6], either elective neck dissection (END) or the watchful waiting policy has been the favored treatment for cT1-2N0 tongue SCC [7, 8]. Investigators favoring for END comment that END allows more accurate disease stage and decision of the need for adjuvant therapies, and resection of metastatic lymph nodes could potentially reduce the recurrence risk [9, 10], the main concern according to the traditional watchful waiting policy is the associated surgical complication including shoulder dysfunction and over-treatment for those patients having no pathologic metastases [11].
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