Primary intraosseous squamous cell carcinoma of the mandible: locoregional control and survival is significantly reduced if the tumour is more than 4 cm in size

doi:10.1016/j.bjoms.2017.11.007

British Journal of Oral and Maxillofacial Surgery

Volume 56, Issue 1, January 2018, Pages 48-53

https://doi.org/10.1016/j.bjoms.2017.11.007 Get rights and content

Abstract

To establish the prognostic factors for primary intraosseous squamous cell carcinoma we designed a retrospective study of patients treated in the head and neck department of a tertiary referral centre in China from 2010–2015. We collected clinical, radiological, and histopathological data from 36 patients treated during the given time period, among which 34 were followed up. There were 22 male and 12 female patients, 13 of whom gave a history of smoking tobacco and four who drank alcohol. All 34 patients were treated by segmental mandibulectomy and neck dissection. Nine had cervical lymph node metastases on histopathological examination, and none had invaded surgical margins. Twenty-eight were treated with radiotherapy postoperatively. During follow up nine died of locoregional recurrence or metastases. Specific factors such as cervical lymph node metastases were related to a greater likelihood of locoregional recurrence. Patients who drank alcohol were also more likely to develop metastases postoperatively. Tumours more than 4 cm in size were significantly associated with reductions in locoregional control and survival.

Introduction

Primary intraosseous squamous cell carcinoma (SCC) is a rare cancer of the head and neck that occurs mainly in the maxilla and the mandible, and is thought to originate from the remnants of odontogenic epithelium.1, 2, 3, 4, 5, 6, 7, 8, 9 It was first named intra-alveolar epidermoid carcinoma by Loos in 1913.⁶ The World Health Organization (WHO) renamed it primary intraosseous carcinoma in 1972.¹⁰ In 2005, WHO categorised it into three subtypes: solid tumours, SCC that arose from odontogenic keratocysts, and SCC that arose from other benign epithelial odontogenic tumours.11, 12

The diagnostic criteria are strict: the lesion must be differentiated from other malignant tumours that invade the mandible. Metastatic tumours from distant sites, sinus carcinoma, and other odontogenic tumours must be identified precisely and excluded.3, 4, 5, 6

Primary interosseous SCC is a subgroup of oral cancers that is by default staged as stage IV by the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC) because of bony involvement, and irrespective of size. Clinical studies are needed to substantiate or challenge the current staging to give a meaningful perception of survival during follow up. The clinical and pathological features are not well understood as there are only a few published papers that have either described a small series or a single case report.

In this study we have retrospectively analysed the cases of primary interosseous SCC from the database of a single tertiary referral hospital to establish the prognostic factors.

Section snippets

Patients and methods

Patients who were operated on at the department of oral and maxillofacial head and neck oncology in our hospital during 2010–15 with a diagnosis of mandibular primary intraosseous SCC were included in the study, and clinical, radiological, and histopathological data were collected. The histopathological diagnosis was confirmed by two experienced pathologists. The mean (SD) duration of follow up was 42 (19) months for surviving patients, and the minimum follow up period was 12 months.

All the

Results

A total of 3407 patients with oral cancer were recorded during the given time period, only 36 of whom fulfilled the inclusion criteria and were diagnosed as primary interosseous SCC. Two were lost to follow up. The data of the remaining 34 patients were analysed for locoregional recurrence, metastases, and overall survival. Nine of the 36 patients died, three from locoregional recurrence, four from pulmonary metastases, and the last two from locoregional recurrence and cervical metastases.

The

Discussion

Primary interosseous SCC is a rare malignancy that affects the mandible, and may develop from the remnants of odontogenic epithelium or an odontogenic cyst or tumour.1, 2, 3, 4, 5, 6, 7, 8, 9 According to previous studies remnant epithelium is the most common cause. A definitive diagnosis of primary interosseous SCC is difficult to establish because it is not easy to differentiate it from SCC that arises from the surface mucosa or other odontogenic sites.15, 16 Accurate clinical, imaging, and

Ethics statement/confirmation of patients’ permission

Ethics approval not required. Patients gave permission for treatment.

Conflict of interest

We have no conflicts of interest.

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The aim of this retrospective, single-center study was to analyze long-term results after marginal and segmental mandibulectomies in patients with oral squamous cell carcinoma (OSCC).
The study included 259 patients treated for OSCC with mandibulectomy between 1996 and 2010. Data acquisition consisted of analysis of operation reports, re-evaluation of histologic bone specimens, and collection of clinical follow-up data.
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Because healthy residual crestal bone height was found in 43% of all patients who had received segmental mandibulectomies, it is conceivable that a significant number of patients would profit from marginal mandibulectomy, at least in cases of absent or erosive bone infiltration pattern, because the residual crestal bone is functionally stable.
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¹: Equal first authors.

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Primary intraosseous squamous cell carcinoma of the mandible: locoregional control and survival is significantly reduced if the tumour is more than 4 cm in size

Abstract

Introduction

Section snippets

Patients and methods

Results

Discussion

Ethics statement/confirmation of patients’ permission

Conflict of interest

Oral Oncol

Int J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Lancet Oncol

Oral Surg Oral Med Oral Pathol

Oral Surg Oral Med Oral Pathol

J Oral Maxillofac Surg

Radiological features of primary intra-osseous carcinoma of the jaws. Analysis of the literature and report of a new case

Dentomaxillofac Radiol