Regional metastasis to anatomies beyond traditional neck dissection boundaries: a multi-institutional analysis focused on unconventional metastases in oral cancer patients

World Journal of Surgical Oncology

Jincai Xue¹  Chunyue Ma²  Zhuowei Tian²  Weijin Gao³  Xiaodan Fang⁴  Zhixiang Li⁵  Cong Yang⁵ 

[1] Department of Head and Neck Surgery, Gansu Province Tumor Hospital, 730050, Lanzhou, Gansu, China;Department of Oral & Maxillofacial–Head & Neck Oncology, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, No. 639, Zhi Zao Ju Road, 200011, Shanghai, China;Department of Oral & Maxillofacial–Head & Neck Oncology, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, No. 639, Zhi Zao Ju Road, 200011, Shanghai, China;Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Wenzhou Medical University, 325000, Wenzhou, Zhejiang, China;Department of Oral and Maxillofacial Surgery, Xiangya Stomatological Hospital, Central South University, 410000, Changsha, Hunan, China;Department of Otolaryngology Head Neck Surgery, The People’s Hospital of Wenshan Prefecture, 663099, Wenshan, Yunnan, China;

关键词: Sublingual;    Buccinators;    Parotid;    Metastasis;    Neck dissections;   

DOI  :  10.1186/s12957-020-02057-6

来源: Springer

【 摘 要 】

BackgroundRegional metastasis sometimes occurs in anatomies that are not included in traditional neck dissections. The purpose of this study was to evaluate the treatment outcomes of squamous cell carcinoma of oral cavity (SCCOC) patients with unconventional metastatic lymph nodes (UMLNs) in sublingual, buccinator, and parotid anatomies.MethodsThis retrospective multi-institutional analysis of squamous cell carcinoma of oral cavity patients with unconventional metastatic lymph nodes was performed from January 2008 to December 2015. All the included patients received surgical treatment for unconventional metastatic lymph nodes. The end point of the study was to determine the factors influencing these patients’ survival and the corresponding solutions to improve survival. Pathological grade, contralateral metastasis, extranodal extension, and other factors were collected and analyzed by logistic regression and the Cox model.ResultsA total of 89 patients were identified. Among these patients, 25 (28.1%) received primary treatment, 28 (31.5%) received staged (therapeutic) neck dissections, and 36 (40.4%) had recurrent or residual diseases. Altogether, 45 patients (51%) had buccinator node metastases, 31 (35%) had sublingual metastases, 12 (14%) had parotid metastases, and 1 had both buccinator and parotid metastases. Regarding regional metastases, 31 patients (34.8%) had isolated unconventional metastatic lymph nodes. Adjuvant therapies were administered to 72 (80.9%) patients, 25 (28.1%) of whom were treated with radio-chemotherapies. The overall survival rate was 38.2%. Multivariate analysis found that the subsites of unconventional metastatic lymph nodes (P = 0.029), extranodal extension in both unconventional metastatic lymph nodes (P = 0.025) and cervical lymph nodes (P = 0.015), sites of primary or recurrent squamous cell carcinoma of oral cavity (P = 0.035), and types of neck dissections (P = 0.025) were significantly associated with overall survival.ConclusionsUnconventional metastatic lymph nodes are uncommon, yet awareness of potential unconventional metastatic lymph nodes should be heightened. Early surgical interventions are warranted in patients with sublingual or buccinator metastases, while caution should be given to those with parotid metastases. Aggressive en bloc (in-continuity) resections may be mandatory in advanced oral cancer cases for close anatomic locations with possible buccal or sublingual metastases.

【 授权许可】

CC BY