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Clinical Spectrum, Pattern, and Level-Wise Nodal Involvement Among Oral Squamous Cell Carcinoma Patients – Audit of 945 Oral Cancer Patient Data

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Abstract

Oral Squamous cell carcinoma (OSCC) is a locoregionally aggressive malignancy. Timely management of neck node dissemination, an important prognostic factor, impacts survival. The aim of the current study was to obtain comprehensive data on patterns or level-wise involvement of neck nodes to optimize neck management in OSCC. It was a retrospective analysis of a prospectively maintained database in a hospital-based setting. The current study evaluated patterns of spread to neck nodes in 945 pathologically proven OSCC patients who underwent neck dissection between 1995 and 2013. Clinical, surgical, pathological, level-wise information of neck nodes was available, and records of these patients were analyzed in relation to the pattern of involvement. Absolute/relative frequency distribution was used to describe the distribution of categorical variables. Continuous measures were organized as mean (standard deviation) and/or median (range). Buccal mucosa (28.78%) was the most common, whereas lip (5.08%) was the least common oral subsite. Modified neck dissection (69.75%) was the most common type of neck dissection. Pathological node positivity was documented in 39.8% patients and Level I(62.54%) and level II(57.33%) are the most common neck levels for nodal involvement. Involvement of Level III to V was seen less often (7.17%). There was no significant association between node positivity among different subsites of oral cancer. Neck level I and II are the most commonly involved levels. Sensitivity and specificity of clinical assessment are 83.51% and 30.05%, respectively. In view of this void in clinical assessment and a predictable nodal spread, alternate node assessment methodology must be explored.

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Authors and Affiliations

  1. Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India

    Suryanarayana Deo, Praveen Royal Mokkapati & Nootan Kumar Shukla

  2. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India

    Vishwajeet Singh & Sada Nand Dwivedi

  3. Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India

    Atul Sharma

  4. Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India

    Ahitagni Biswas

Authors
  1. Suryanarayana Deo
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  2. Vishwajeet Singh
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  3. Praveen Royal Mokkapati
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  4. Nootan Kumar Shukla
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  5. Sada Nand Dwivedi
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  6. Atul Sharma
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  7. Ahitagni Biswas
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Correspondence to Suryanarayana Deo.

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Key Messages

Nodal spread in OSCC is predictable and skip metastasis might be much lower in a tobacco chewing setting. With these findings and poor specificity of clinical assessment for neck nodes, there is an element of overtreatment using the current management guidelines.

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Deo, S., Singh, V., Mokkapati, P.R. et al. Clinical Spectrum, Pattern, and Level-Wise Nodal Involvement Among Oral Squamous Cell Carcinoma Patients – Audit of 945 Oral Cancer Patient Data. Indian J Surg Oncol 11, 86–91 (2020). https://doi.org/10.1007/s13193-019-01011-7

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