Abstract
The presence of metastatic lymph nodes is a relevant prognostic factor in oral cancer. ObjectiveThis paper aims to assess metastatic lymph node density (pN+) in patients with tongue and floor-of-mouth squamous cell carcinoma (SCC) and the association of this parameter with disease-free survival (DFS). Materials and MethodsA group of 182 patients seen between 1985 and 2007 was included, 169 of which were males. Five were on stage I, 35 on stage II, 56 on stage III, and 85 on stage IV. Median values were considered in lymph node density assessment, and the Kaplan-Meier curve was used to evaluate DFS; survival differences within the group were elicited through the log-rank test. ResultsAn average 3.2 metastatic lymph nodes were excised from the patients in the group. Density ranged from 0.009 to 0.4, with a mean value of 0.09. Five-year DFS rates were of 44% and 28% for the groups with lymph node densities below and above the median respectively (p = 0.006). Two-year local/regional control was achieved for 71% and 49% for the patients below and above the median density respectively (p = 0.01). In terms of pN staging, local/ regional control was achieved in 70% and 54% of pN1 and pN2 patients respectively, albeit without statistical significance (0.20%). ConclusionLymph node density may be used as a prognostic indicator for tongue and floor-of-mouth SCC.
Highlights
Neck clearance is a standard procedure used to stage and treat regional metastases of upper respiratory and digestive tract malignant tumors
An average 3.2 metastatic lymph nodes were excised from the patients in the group
Five-year disease-free survival (DFS) rates were of 44% and 28% for the groups with lymph node densities below and above the median respectively (p = 0.006)
Summary
Neck clearance is a standard procedure used to stage and treat regional metastases of upper respiratory and digestive tract malignant tumors. Metastatic lymph nodes are among the most relevant findings in diagnosing advanced disease (stages III and IV). The TNM staging system is the main prognostic indicator in use today, but recent studies have pointed out that lymph node density allows for better prognostic accuracy in pN+ patients[1,2]. This study looks into lymph node density in tongue and floor-of-mouth epidermoid carcinoma patients while considering local/regional control and survival
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