Cervical Metastasis in Patients with Gingivo-Alveolar Complex Squamous Cell Carcinoma- A Cross Sectional Study
DOI:
https://doi.org/10.52206/jsmc.2024.14.4.872Abstract
Background: The aggressive nature of squamous cell carcinoma is evident due to early bone invasion and metastasis, which are crucial factors influencing prognosis in cancer patients.
Objective: To assess cervical metastasis among patients with squamous cell carcinoma of the gingivo-alveolar complex.
Materials and Methods: One hundred and forty cases of squamous cell carcinoma of the gingivo-alveolar complex were confirmed through incisional/excisional biopsy under local/general anesthesia. Grading was performed in the same laboratory to prevent bias. Comprehensive histories were taken, followed by clinical examinations to palpate cervical lymph nodes across all levels. All patients were advised to undergo CT scans for occult nodal metastasis. The Chi-Square test was used to analyze the association of lymph node involvement and metastasis with age and gender.
Results: Of total 114 (81.4%) were males, and 26 (18.6%) were females, with a mean age of 52.7±10.24 years. Level I was the most common presenting stage, observed in 64 (45.71%) of OSCC cases, followed by combined level I & II and level I-IV in 9.29% and level II in 2.14% of cases. Lymph node involvement was absent (no metastasis) in 32.14% of cases. Males showed higher lymph node involvement at each level compared to females, with statistically insignificant age-wise differences. Metastasis was observed in more than half of the cases, with the mandible (76.6%) being more commonly affected than the maxilla (23.6%).
Conclusion: Cervical metastasis is more frequently seen in the mandible, primarily extending up to level I, and is more common in males.
Keywords: Cervical metastasis, Lymph nodes, Oral squamous cell carcinoma, Stages of oral squamous cell carcinoma.
References
Gross ND, Miller DM, Khushalani NI, Divi V, Ruiz ES, Lipson EJ, et al. Neoadjuvant cemiplimab for stage II to IV cutaneous squamous-cell carcinoma. New Engl J Med. 2022;387(17):1557-68. DOI: https://doi.org/10.1016/S1470-2045(23)00459-X
Stepan KO, Mazul AL, Larson J, Shah P, Jackson RS, Pipkorn P, et al. Changing epidemiology of oral cavity cancer in the United States. Otolaryngol. 2023 ;168(4):761-8. DOI: https://doi.org/10.1177/01945998221098011
Voizard B, Khoury M, Saydy N, Nelson K, Cardin GB, Létourneau-Guillon L, et al. Preoperative evaluation of depth of invasion in oral tongue squamous cell carcinoma: A systematic review and meta-analysis. Oral Oncol. 2023;136:1062-73. DOI: https://doi.org/10.1016/j.oraloncology.2022.106273
Yang Z, Sun P, Dahlstrom KR, Gross N, Li G. Joint effect of human papillomavirus exposure, smoking and alcohol on risk of oral squamous cell carcinoma. BMC Cancer. 2023;23(1):45-7. DOI: https://doi.org/10.1186/s12885-023-10948-6
Xie W, Mridha MK, Gupta A, Kusuma D, Butt AM, Hasan M, et al. Smokeless and combustible tobacco use among 148,944 South Asian adults: a cross-sectional study of South Asia Biobank. BMC Public Health. 2023 Dec 9;23(1):2465. DOI: https://doi.org/10.1186/s12889-023-17394-w
Subramaniam P, Olsen CM, Thompson BS, Whiteman DC, Neale RE. Anatomical distributions of basal cell carcinoma and squamous cell carcinoma in a population-based study in Queensland, Australia. JAMA Dermatol. 2017;153(2):175-82. DOI: https://doi.org/10.1001/jamadermatol.2016.4070
Begum N, Naheed G, Nasreen S, Khan A. Oral cavity cancers in North West pakistan: a hospital based study. J Postgrad Med Inst. 2011;23(1):31-34.
Ilagan FMD, Wu Y-H. Blastomycosis-like pyoderma: A pitfall for the misdiagnosis of squamous cell carcinoma. J Cutaneous Pathol. 2022;49(12): 1035-39. DOI: https://doi.org/1035-9.10.1111/cup.14298
Yoshida S, Shimo T, Murase Y, Takabatake K, Kishimoto K, Ibaragi S, et al. The prognostic implications of bone invasion in gingival squamous cell carcinoma. Anticancer Res. 2018;38(2):955-62. DOI: https://doi.org/10.21873/anticanres.12309
Cheng Y, Li S, Gao L, Zhi K, Ren W. The molecular basis and therapeutic aspects of cisplatin resistance in oral squamous cell carcinoma. Front Oncol. 2021;11:7613-79. DOI: https://doi.org/10.3389/fonc.2021.761379
Shah I, Sefvan O, Luqman U, Ibrahim W, Mehmood S, Alamgir W. Clinical stage of oral cancer patients at the time of initial diagnosis. J Ayub Med Coll Abbottabad. 2010;22(3):61-3. PMID: 22338419
Thakare E, Gawande M, Chaudhary M, Seralathan M, Kannan K. Detection of micrometastasis in lymph nodes of oral squamous cell carcinoma: A comparative study. J Oral Maxillofac Pathol. 2013;17(3):374. DOI: https://doi.org/10.4103/0973-029X.125202
Dias FL, Lima RA, Kligerman J, Farias TP, Soares JRN, Manfro G, et al. Relevance of skip metastases for squamous cell carcinoma of the oral tongue and the floor of the mouth. Otolaryngol Head Neck Surg. 2006;134(3):460-5. DOI: https://doi.org/10.1016/j.otohns.2005.09.025
Shenoi R, Devrukhkar V, Sharma B, Sapre S, Chikhale A. Demographic and clinical profile of oral squamous cell carcinoma patients: A retrospective study. Ind J Cancer. 2012;49(1):21. DOI: https://doi.org/10.4103/0019-509X.98910
Patel SC, Carpenter WR, Tyree S, Couch ME, Weissler M, Hackman T, et al. Increasing incidence of oral tongue squamous cell carcinoma in young white women, age 18 to 44 years. J Clin Oncol. 2011;29(11):1488-94. DOI: https://doi.org/10.1200/JCO.2010.31.7883
Rahman N, MacNeill M, Wallace W, Conn B. Reframing histological risk assessment of oral squamous cell carcinoma in the era of UICC 8th edition TNM staging. Head Neck Pathol. 2021;15:202-11. DOI: https://doi.org/10.1007/s12105-020-01201-8
Wunschel M, Neumeier M, Utpatel K, Reichert TE, Ettl T, Spanier G. Staging more important than grading? Evaluation of malignancy grading, depth of invasion, and resection margins in oral squamous cell carcinoma. Clin Oral Investigat. 2021;25:1169-82. DOI: https://doi.org/10.1007/s12105-020-01201-8
Martin T WKLaocIWJ, Gilbert RW MK, McGarry G. Textbook of Head and Neck Surgery and Oncology. 7th ed: London: Hodder Arnold; 2022; p.233.
Andrade M, Jacomo A. Anatomy of the human lymphatic system. Cancer Treat Res. 2007;135:55. PMID: 17953408
El-Naaj IA, Leiser Y, Shveis M, Sabo E, Peled M. Incidence of oral cancer occult metastasis and survival of T1-T2N0 oral cancer patients. J Oral Maxillofac Surg. 2011;69(10):2674-9. DOI: https://doi.org/10.1016/j.joms.2011.02.012
Rahim DU, Siddiqui AH, Ahmed Z, Marfani MS. Frequency of Cervical Metastasis in Oral Cancer. Pak J Otolaryngol. 2013;29:80-3.
De Zinis LOR, Bolzoni A, Piazza C, Nicolai P. Prevalence and localization of nodal metastases in squamous cell carcinoma of the oral cavity: role and extension of neck dissection. Eur Arch Oto-Rhino-Laryngol Head Neck. 2006;263(12):1131-5. DOI: https://doi.org/10.1007/s00405-006-0128-5
Lea J, Bachar G, Sawka AM, Lakra DC, Gilbert RW, Irish JC, et al. Metastases to level IIb in squamous cell carcinoma of the oral cavity: A systematic review and meta-analysis. Head Neck. 2010;32(2):184-90. PMID: 19626638
Vigneswaran N, Williams MD. Epidemiologic trends in head and neck cancer and aids in diagnosis. Clin North Am. 2014;26(2):123-41. DOI: https://doi.org/10.1016/j.coms.2014.01.001
Kumar G, Manjunatha B. Metastatic tumors to the jaws and oral cavity. J Oral Maxillofac Pathol. 2013;17(1):71. DOI: https://doi.org/10.4103/0973-029X.110737
Additional Files
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 The authors retain the copyrights. Authors are permitted and encouraged to post their work online (e.g. in institutional repositories or on their website), as it can lead to productive exchanges, as well as greater citation of published work.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Readers may “Share-copy and redistribute the material in any medium or format” and “Adapt-remix, transform, and build upon the material”. The readers must give appropriate credit to the source of the material and indicate if changes were made to the material. Readers may not use the material for commercial purpose. The readers may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.