Surgical Principles and Approaches to Gingivobuccal Cancers.

Aims and objectives (1) To study the depth of tumor invasion in an oral (tongue and buccal mucosa) carcinoma and its correlation with neck metastasis. (2) To know whether the increase in depth of tumor (depth of invasion) increases the chances of cervical nodal metastasis in the oral tongue and buccal mucosa carcinoma and derive cutoff value of depth of invasion at which the metastasis occurs. Materials and methods The study was carried out on 14 tongue and 22 buccal mucosa cases to know the correlation between the depth of tumor and neck node metastasis in the oral (tongue and buccal mucosa) carcinoma. Results Among 36 cases, 10 cases were pN+. Out of 10 cases, 7 (70%) were having depth ≥12 mm and 30% cases (pN+) having depth between 8 and <10. We found it statistically significant and so as the depth of tumor increases the chances of nodal metastasis increases. We found the cutoff for a depth of invasion in both tongue and buccal mucosa carcinomas as 8 out of 22 patients had DOI >10 mm and among them 4 were pN+ and among 14 tongue cases, 3 cases had DOI >8 mm and all of them were pN+. Conclusion For tongue 8 mm and for buccal mucosa, 10 mm of the depth of tumor invasion was calculated as the cutoff depth, above which the incidence of nodal metastasis increases to 75% and 66.66%, respectively. Clinical significance Depth of tumor is an important prognostic indicator in the tongue and buccal mucosa carcinoma to know the cervical nodal metastasis. Hence for an increase in depth of tumor cases, neck must be addressed along with primary tumor excision. Radiological investigations [ultrasonography (USG), magnetic resonance imaging (MRI), computed tomography (CT) scan] play an important role in nodal metastasis detection hence should be considered in carcinoma of the oral tongue and buccal mucosa especially in clinically N0 neck. How to cite this article Shah AH, Parikh RP. Clinicopathological Correlation between Depth of Tumor and Neck Node Metastasis in Oral (Tongue and Buccal Mucosa) Carcinoma. Int J Head Neck Surg 2021;12(1):6–10.

This study aims to analyze and compare the clinical and pathological characteristics of anorectal malignant melanoma (AMM) among Chinese patients and those from East Asia. Clinical data of 17 AMM patients who were treated at Jiangsu Province Hospital (JPH) in China from 2013 to 2023 were collected, and further compared with 544 East Asia AMM patients reported in 20 literature materials from 2011 to 2023. Furthermore, the 4-fold table of the Pearson Chi-square test was used to calculate and compare the pathological characteristics of AMM patients in JPH and East Asia. Fisher exact probability was performed to statistically analyze the relationship between clinical–pathological indicators and lymphatic metastasis in AMM patients in JPH. The median age of initial diagnosis for AMM patients in JPH and East Asia were 69 years and 61.4 years, respectively. Several medical indicators are similar between the JPH and East Asian patients, and the differences are not statistically significant (P > .05), including gender, S-100 Protein, Human Melanoma Black 45, Ki-67, tumor size, lymphatic metastasis, and surgical approach. Moreover, indicators showed differences (P < .05) are tumor location, Melanoma Antigen Recognized by T cells 1, depth of invasion, clinical stage, and adjuvant therapy. In AMM patients in JPH, lymphatic metastasis is significantly correlated with tumor size and depth of invasion (P = .017 and .004, respectively). In AMM patients from JPH, lymphatic metastasis is significantly correlated with tumor size and depth of invasion. More indicators are similar between AMM patients in JPH and East Asia populations, such as gender, S-100 Protein, Human Melanoma Black 45, Ki-67, tumor size, lymphatic metastasis, and surgical approach, while less indicators have differences.

The most important prognostic factor for early gastric cancer (EGC) is the lymph node status. It is important to predict early lesions without lymph node metastasis (LNM) before proceeding to radical surgery in locally excised lesions. Tumor budding is a feature known to be related to aggressive tumor behavior in several solid tumors. We aimed to assess the predictive value of tumor budding for LNM in pT1a and pT1b gastric cancer. We retrospectively investigated radical gastrectomy specimens for of 126 EGC patients and assess the possible relation between the clinicopathologic features, including age, gender, tumor location, tumor size, macroscopic tumor type, histologic differentiation, depth and width of submucosal invasion, lymphovascular invasion, and tumor budding with lymph node involvement. Among the 126 EGCs, 38 were stages as pT1a and 88 as pT1b. LNM rate in pT1a tumors was 13% whereas it was 33% in pT1b tumors. Tumor budding was the only factor significantly and independently related to LNM in pT1a patients. Female gender and tumor budding were found to be independent risk factors in pT1b group. Other clinicopathologic features were not related to LNM. Based on these results, we suggest that budding is a promising parameter to assess for prediction of LNM in EGC removed by endoscopic surgery, and to decide on the appropriate surgical approach.

To explore the feasibility of performing minimally invasive surgery (MIS) on subsets of submucosal gastric cancers that are unlikely to have regional lymph node metastasis. A total of 105 patients underwent radical gastrectomy with lymph node dissection for submucosal gastric cancer at our hospital from January 1995 to December 1995. Besides investigating many clinicopathological features such as tumor size, gross appearance, and differentiation, we measured the depth of invasion into submucosa minutely and analyzed the clinicopathologic features of these patients regarding lymph node metastasis. The rate of lymph node metastasis in cases where the depth of invasion was <500 microm, 500-2000 microm, or >2000 microm was 9% (2/23), 19% (7/36), and 33% (15/46), respectively (P<0.05). In univariate analysis, no significant correlation was found between lymph node metastasis and clinicopathological characteristics such as age, sex, tumor location, gross appearance, tumor differentiation, Lauren's classification, and lymphatic invasion. In multivariate analysis, tumor size (>4 cm vs <=2 cm, odds ratio = 4.80, P = 0.04) and depth of invasion (>2000 microm vs <=500 microm, odds ratio = 6.81, P = 0.02) were significantly correlated with lymph node metastasis. Combining the depth and size in cases where the depth of invasion was less than 500 microm, we found that lymph node metastasis occurred where the tumor size was greater than 4 cm. In cases where the tumor size was less than 2 cm, lymph node metastasis was found only where the depth of tumor invasion was more than 2000 microm. MIS can be applied to submucosal gastric cancer that is less than 2 cm in size and 500 microm in depth.

Skin cancer is the most common cancer. Melanoma composes less than 4% of total cases but is the cause of most skin cancer deaths. However, in the United States, melanoma has the fifth highest rate of incidence of all cancers with an average 93.5% 5-year survival rate. However, when melanoma spreads either to regional lymph nodes or to distant organs, the prognosis drops significantly, so there is a critical need to identify patients at risk for tumor spread. The objective of this research project is to determine the correlation between tumor depth and anatomic location with metastasis outcomes. We identified a cohort of 923 Stage 1 &amp; 2 patients (those without lymph node metastases) from the Indiana University Simon Cancer Center Registry with an average follow up of 4 years (Std. dev = 3.2). We retrieved the clinicopathologic descriptions of their melanomas using a database from the IU Pathology department. Patients were stratified by tumor stage, location, and depth of invasion, and survival rates were analyzed Cox proportional hazard models and log-rank tests. Kaplan-Meier plots were generated with the survminer package. The results of the study indicate that there is no difference in metastasis for patients with similar levels of tumor invasion but different anatomic locations. Unexpectedly, multivariate cox regression showed that mitotic count was a stronger predictor of metastasis than tumor invasion. These results indicate that there is a need for bioinformatic tools to more accurately quantify semi-quantitative measures of tumor morphology. This would allow for rigorous research and higher precisions prognostic tools.

Depth of Tumor Invasion Independently Predicts Lymph Node Metastasis in T2 Rectal Cancer

Background: CDX2 has been established as a good prognostic marker for colorectal carcinomas. Differentiated adenocarcinomas are characterized by higher CDX2 expression than undifferentiated tumors with stronger reactivity in intestinal phenotypes. There is a close correlation between the degree of tumor differentiation and the Ki-67 score. It was also observed that strong CDX2 expression was associated with low Ki-67 index whereas negative or dim CDX2 expression was associated with high Ki-67 index. Methods: Gastric biopsies and gastrectomy specimens with gastric carcinoma were evaluated clinicopathologically and processed for immunohistochemistry (IHC) staining to assess CDX2 and Ki-67 expression. The relationship between 2 markers and each clinicopathological parameter was evaluated. Data was statistically analysed. P&lt;0.05 were taken for statistical significance. Results: The study was done on 57 gastric adenocarcinoma cases with mean age 56.12 years. No significant correlation was found between CDX2 &amp; Ki-67 with clinical, gross &amp; microscopic parameters except for tumor location and depth of invasion. Significant correlation was detected between CDX2 (p=0.04) &amp; Ki-67 (p=0.03) with tumor location. Depth of tumor invasion was significantly associated with Ki-67 (p=0.013). No significant association between CDX2 and Ki-67 was observed. Conclusion: The statistical correlation between CDX2 &amp; Ki-67 with clinicopathological parameters proves that CDX2 &amp; Ki-67 to be the independent markers with respect to tumor site and depth of invasion (in case of Ki-67). But due to lack of association of CDX2 with Ki-67 further studies need to be done with higher sample size.

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Many histopathologic parameters in head and neck squamous cell carcinoma have been identified as predictive factors for cervical metastasis. Several studies focused on tumor thickness, and the depth of invasion was suggested to have a relationship to the occurrence of cervical metastasis. Nonetheless, the criterium for elective neck therapy in terms of tumor depth is still inconclusive. Therefore, a retrospective study was undertaken to substantiate the differing results in the literature with our own findings concerning the interrelationship between tumor thickness and clinically suspicious neck, as well as occult neck disease. In addition, the study attempted to identify further predictive factors for cervical metastasis in squamous cell carcinoma of the tongue. The medical records of 34 primary tongue carcinomas operated without any preoperative therapy between 1980 and 1991 were reviewed. Each patient's tumor type, tumor location, tumor size, invasion mode, depth of invasion, intralymphatic tumor emboli, and perineural invasion were evaluated. Chi-square contingency tables were used to correlate clinical or histopathologic parameters with metastasis in the neck. The overall cervical metastatic rate was 35.3% (n = 12/34). In univariate analysis, invasion mode and depth of invasion were statistically significant predictors of regional metastasis at p = 0.0019 and p = 0.0003, respectively. In the group in which tumor depth exceeded 5 mm, the metastatic rate was 64.7% (11/17). In contrast, when the depth of invasion was less than 5 mm, the incidence of cervical metastasis was 5.9% (1/17). Clinically negative necks turned out pathologically positive in 30.0% (n = 9/30). The tumor depth exceeded 5 mm in 43.4% (13/30) of the N0 necks. In the conversion (N0-->N1) group, tumor depth exceeding 5 mm was noted in 88.9% (n = 8/9). We suggest that there is a discerning point at 5 mm of tumor depth at which cervical metastasis is probable. Electric neck therapy (surgery or irradiation) is strongly indicated for tumors exceeding 5 mm invasion. Tumor invasion mode and tumor size also bear an impact on the indication for therapy.

Gastric cancer is occasionally diagnosed using transabdominal ultrasonography (US) during screening or investigation of patients with abdominal symptoms. Therefore, the present study analyzed the association of the tumor diameter, pathological T (pT) staging and depth of invasion with the detection of gastric cancer using US. Patient records were analyzed retrospectively and 13 patients were enrolled, who underwent US screening prior to endoscopic mucosal resection, endoscopic submucosal dissection or surgery. In total, 5 patients were diagnosed with gastric cancer using US (positive detection group), while US was unable to detect the gastric cancer in 8 patients (negative detection group). The tumor diameter and depth of invasion were determined by pathologists. One-way analysis of variance or the χ2 test was performed. Wall thickness in gastric cancer cases ranged between 7 and 20 mm (mean, 12.2±5.9 mm), as measured using abdominal US. The hemoglobin level was significantly lower in the positive detection patients compared with the negative detection patients (P=0.0455). In addition, the diameters of the gastric wall in the negative and positive detection patients were 24.5±16.4 and 54.4±26.2 mm, respectively (P=0.0266). These results indicate that gastric cancer in the positive detection patients were at a more advanced-stage compared with that in the negative detection patients. Furthermore, gastric cancer with a stage over pT2 was diagnosed using abdominal US (P=0.0242), whereas stage pT1a gastric cancer was not detected by abdominal US. Gastric tumors invading deeper than the submucosa were diagnosed using US (P=0.0242). However, the gastric cancer cases limited to the mucosa remained undetected. In conclusion, the detection of gastric cancer correlated well with the tumor diameter, pT staging and depth of invasion.

Predictors of final histology in patients with endometrial cancer

In submucosal invasive adenocarcinoma of the esophagogastric junction (pT1b-SM AEG), the extent of tumor submucosal (SM) invasion is measured using the vertical depth of SM invasion with the muscularis mucosa. This study aimed to investigate whether tumor thickness and depth of invasion without accounting for muscularis mucosa were superior to the vertical depth of SM invasion as metastasis predictors. We enrolled patients with pT1b-SM AEG who underwent endoscopic resection or surgical resection (SR) at our institution between January 2011 and September 2019 and were followed up for ≥2years. The relationship between metastasis and clinicopathological factors was examined. Metastasis was defined as pathologically confirmed lymph node metastasis in the surgical specimen or recurrence during follow-up. This study included 57 patients (44 men; median age, 72years). Endoscopic resection and SR were performed in 16 and 41 patients, respectively. Nine patients were diagnosed with metastasis: five who underwent SR showed pathologically confirmed lymph node metastasis in the surgical specimens, and four experienced recurrences during a median follow-up of 48months. Univariate analyses showed that tumor thickness was significantly associated with metastasis (P = 0.021), and the vertical depth of SM invasion (P = 0.48) and depth of invasion (P = 0.38) were not. Furthermore, in multivariate analysis, tumor thickness ≥2800μm (odds ratio, 38.70; P = 0.013) was a significant predictor for metastasis. Tumor thickness may be a more convenient and useful predictor of metastasis in patients with pT1b-SM AEG than the vertical depth of SM invasion.

AGA Clinical Practice Update on the Utility of Endoscopic Submucosal Dissection in T1b Esophageal Cancer: Expert Review

Curative surgery for remnant gastric cancer (RGC) after gastrectomy for gastric cancer (GC) can be challenging. We examined the risk factors for lymph node metastasis in RGC, especially for tumors located at the greater curvature (G) or non-greater curvature (NG), to determine the appropriate indications of curative surgery. Data from the two high-volume centers of Japan between 1998 and 2018 were retrospectively reviewed. Among the 137 patients enrolled in this study, 34 were classified as the G group and 103 as the NG group. The incidence of lymph node metastasis and its risk factors was evaluated. Lymph node metastasis was observed in 21.2% (29/137), including 38.2% (13/34) in the G group and 15.5% (16/103) in the NG group (p = 0.008). A logistic regression analysis showed that tumor location of G or NG (p = 0.042), tumor size (p = 0.002) and depth of invasion (p = 0.009) were significant independent risk factors for nodal metastasis. Risk classification using these factors showed that clinical T1-T2 with a maximum size < 35mm located at the non-greater curvature had the lowest nodal metastatic risk (4.3%). Tumor location at the G or NG was a significant risk factor for nodal metastasis in RGC. When selecting curative surgery for RGC, physicians should consider the nodal metastatic risk calculated by the tumor location, size and depth of invasion.