OP130: Clinico-pathological correlation of advanced gingivo-buccal complex cancer with nodal status

Abstract

Objective (a) To elucidate the pathological significance of clinical and radiological lymph node enlargement in cases with T3/T4 cancer of the gingivo-buccal complex. (b) To elucidate the prognostic impact of pathological lymph node metastasis in T3/T4 cancer of the gingivo-buccal complex. Methods 90 cases of gingivo-buccal complex cancer were surgically treated at a single institute (All India Institute Of Medical Sciences, New Delhi) from year 2007 to 2010. All data was collected prospectively. 78 cases were evaluable; 12 cases were excluded for inadequacy of data recording. All cases had excision of primary supplemented with a neck dissection (selective neck dissection 35, comprehensive neck dissection 43). All cases had post- operative radiotherapy. Clinical and radiological N stages were compared with final pathological N stage and subsequent follow-up status. Cases were followed-up for a period ranging from 3 months to 24 months. Results 33 cases were clinically staged as N0 and only 2 of these 33 were noted to have lymph node metastasis on pathological evaluation of the neck dissection. However, 52 cases were N+ on clinical evaluation. Final pathology confirmed disease in 26/52 and 26/52 did not manifest pathological metastasis in the clinically enlarged nodes. The pN0 group had a significantly better treatment outcome (76.1% disease -free in follow-up) as compared to pN + group ( 20% disease-free in follow-up) ( p Conclusions (a) Selective neck dissection may not be necessary in clinical and radiological N0 neck as incidence of occult metastasis is low. (b) Clinically N+ neck has high incidence of false positivity (50%). (c) Pathologically N+ neck has poor treatment outcome as compared to pN0 neck.