Metastatic pattern in squamous cell carcinoma of the hard palate and maxillary alveolar ridge: clinical experience and review of the literature

Abstract

Oral squamous cell carcinoma of the hard palate and upper alveolar ridge is rare with only few published current data regarding regional metastases after elective neck dissection or adjuvant therapy. Our aim was to investigate the incidence of initial and delayed nodal metastasis and to identify predictive factors. In a retrospective cohort study, we enrolled 48 primarily surgical-treated patients from 2004 to 2014. Pathological initial nodal metastasis rate was 13.3% (6/45). Poor histologic grade (p = 0.048), lymphovascular infiltration (p < 0.001) and perineural infiltration (p = 0.01) correlated with initial nodal metastasis, while advanced T-stage showed no significance (p = 0.07). Regional recurrences occurred in 14.6% of patients (7/48) and tended to emerge less frequently after therapeutic than elective neck dissection. Tumor involvement of the vestibular alveolar mucosa was a prognostic factor for developing regional recurrence (p = 0.034). Overall nodal disease rate was 27.1% (13/48). Disease-free and overall survival rates were at 73 and 93%, respectively. The presence of poor histologic characteristics is a high risk for nodal metastasis. In patients with tumors in contact with the upper vestibular fold, the hypothesis of an impact on metastasis needs further validation.