The characteristics and treatment results of squamous cell carcinomas of oral tongue

Ki-Ho Kim; Eun-Joo Choi; Hyung-Jun Kim; Woong Nam; In-Ho Cha

doi:10.5125/jkaoms.2011.37.1.15

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Kim, Choi, Kim, Nam, and Cha: The characteristics and treatment results of squamous cell carcinomas of oral tongue

Original Article

J Korean Assoc Oral Maxillofac Surg 2011;37(1):15-20.

Published online: 10 January 2011

DOI: https://doi.org/10.5125/jkaoms.2011.37.1.15

The characteristics and treatment results of squamous cell carcinomas of oral tongue

Ki-Ho Kim¹, Eun-Joo Choi¹, Hyung-Jun Kim^1,³, Woong Nam^1,², In-Ho Cha^1,²

¹Department of Oral and Maxillofacial Surgery, Yonsei University, Seoul, Korea

²Oral Cancer Research Institute, Yonsei University, Seoul, Korea

³Research Center for Orofacial Hard Tissue Regeneration, College of Dentistry, Yonsei University, Seoul, Korea

In-Ho Cha Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University 250 Seongsanno, Seodaemoon-gu, Seoul, 120-752, Korea TEL: +82-2-2228-3140 FAX: +82-2-2227-8022 E-mail: cha8764@yuhs.ac

Received 10 October 2010 Revised 14 January 2011 Accepted 9 February 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction

The characteristics of oral tongue squamous cell carcinomas (SCC) and the treatment results were reviewed to determine the appropriate treatment strategies.

Materials and Methods

The medical records of 140 patients diagnosed and treated for oral tongue SCC at Yonsei University Health System from January 1995 to December 2004 were reviewed. For statistic analysis, the survival rate was determined using the Kaplan-Meier method with SPSS version 12.0, and the difference in survival rates was evaluated using a log-rank test.

Results

The mean age of the patients with oral tongue SCC patients was 55 (19–85 years old). According to the T, N and pathologic stage, the patients were distributed from a higher to a lower incidence of cases, as follows: T2 (46.4%), T1 (37.9%), T4 (8.5%), and T3 (7.1%); N0 (65%), N1 (20.7%), N2 (13.6%), and N3 (0.7%); and stage Ⅰ (31.4%), stage Ⅱ (25.7%), stage Ⅳ (22.2%), and stage Ⅲ (20.7%). Local and regional recurrence and distant metastasis was present in 13.6%, 5% and 4.2% of patients, respectively. The five-year survival rate was 72.2%, and the prognostic factors for oral tongue SCC included neck metastasis, pathologic stage of the disease, cell differentiation, treatment modality, neck dissection as part of the treatment plan, and neck node recurrence.

Discussion

It is suggested that ipsilateral neck dissection or bilateral neck dissection should be selected as a treatment of tongue SCC patients with advanced stage.

Keywords: Squamous cell carcinoma, Tongue neoplasms, Mouth neoplasms, Neoplasm staging, Retrospective studies, Survival rate

References

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Table 1.

Distributions and survival rates of oral tongue SCC patients according to clinical and histological characteristics, treatment modality and prognosis

		Cases (n=140)	Percentage of cases (%)	5-year survival (%)	P value
Gender
	Male	94	67.1	72.6	>0.05
	Female	46	32.9	71.5	>0.05
Smoking¹ (n=125)
	Smoker	38	30.4	68.3	>0.05
	Non-smoker	87	69.6	74.8	>0.05
Pathologic T stage
	T1	53	37.9	77.4
	T2	65	46.4	70.5	>0.05
	T3	10	7.1	68.5	>0.05
	T4	12	8.6	52.5
Tumor size
	<2 cm	53	37.9	77.4	>0.05
	≥2 cm	87	62.1	68.7	>0.05
Pathologic N stage
	N0	91	65	78.1
	N1	29	20.7	51.5
	N2a, b	15	10.7	67.1	<0.05
	N2c	4	2.9	66
	N3	1	0.7	NA²
Neck metastasis
	Negative	91	65	78.1	<0.05
	Positive	49	35	60.3	<0.05
Pathologic Stage
	Ⅰ	44	31.4	82.4
	Ⅱ	36	25.7	74.1	<0.05
	Ⅲ	29	20.7	59.3	<0.05
	Ⅳ	31	22.2	64.7
Stage (divided as early/ late)
	Early	79	564	78.8	<0.05
	Late	61	43.6	62.2	<0.05
Cell differentiation³ (n=115)
	Well	49	42.6	67.9
	Moderate	55	47.8	73.6	<0.05
	Poor	11	9.6	36.3
Surgical margin
	Negative	122	87.1	76.5
	Positive	11	7.9	40	>0.05
	Epithelial dysplasia	7	5	57.1
Perineural invasion, perivascular invasion
	Positive	4	2.8	NA
Treatment modality
	Surgery only	77	55	84.1	<0.05
	Combined therapy	63	45	60.2
Method of neck dissection
	No neck dissection	31	22.1	91.2
	Ipsilateral selective⁴	14	10	70.8
	Ipsilateral radical⁵	48	34.3	87.5	<0.05
	Bilateral (selective+selective)	33	23.6	61.7
	Bilateral (radical+selective)	14	10	61.5
Local recurrence
	No recurrence	121	86.4	71.7	<0.05
	Recurrence	19	13.6	60	<0.05
Neck recurrence
	No recurrence	133	95	74.9	<0.05
	Recurrence	7	5	NA	<0.05

Smoking

¹ 125 patients were identified whether they smoke in entire 140 patients, NA

² the number of included cases is too small to analyzed statistically, Cell differentiation

³ identified in pathologic reports of 115 patients in entre 140 patients, Ipsilateral selective

⁴ neck dissection including level I, II, or III selectively such as suprahyoid neck dissection and supraomohyoid neck dissection, Ipsilateral radical

⁵ radical and modified radical neck dissection, SCC: squamous cell carcinoma.)

Table 2.

Distributions of oral tongue SCC patients according to T, N stage (unit: n)

	T1	T2	T3	T4
N0	48	40	6	10
N1	10	19	3	6
N2a	0	5	2	0
N2b	3	8	1	2
N2c	0	4	0	3
N3	0	1	0	0

(SCC: squamous cell carcinoma, T: tumor, N: node)

Table 3.

The recurrence rate and 5-year survival rate after neck dissection methods applied as pathologic stage of neck metastasis

		no ND (n)	Ipsilateral elective ND	Ipsilateral radical ND	Bilateral elective ND (elective+elective)	Bilateral radical ND (radical+elective)
Neck metastasis
Pathologically negative	Percentage (No. of cases/Total cases) 5-year survival	3.2%^*	3.0%	0.0%	9.0%	0.0%
		(1/31^**)	(1/33)	(0/3)	(2/22)	(0/2)
		91.2%	74.3%	NA	71.4%	NA^**
Pathologically	Percentage (No. of cases/Total cases) 5-year survival	NC****	0.0%	9.0%	18.1%	0.0%
Pathologically positive			(0/15)	(1/11)	(2/11)	(0/12)
Pathologically positive			60.6%	83.3%	41.1%	63.6%
Stage
Early stage (Ⅰ, Ⅱ)	Percentage (No. of cases/Total cases) 5-year survival	3.2%	0.0%	0.0%	13.3%	0.0%
		(1/31)	(0/30)	(0/2)	(2/15)	(0/1)
		91.2%	84.5%	NC	61.5%	NA
Late stage (Ⅲ, Ⅳ)	Percentage (No. of cases/Total cases) 5-year survival		5.5%	7.1%	11.1%	0.0%
		NC	(1/18)	(1/12)	(2/18)	(0/13)
			50.3%	83.3%	61.2%	66.6%

^* 3.2 percentage of (included cases with neck failure)/(included entire cases) ×100 (%), 1/31

^** included cases with neck failure/included entire cases, NA

¹ the number of included cases is too small to analyzed statistically, NC

² no cases included, ND: neck dissection.)

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