Prognostic value of lymph node involvement in oral cancers: A study of 137cases

Objective: The aim of this study was to assess the prognostic value of lymp h node involvement in patients with squamous cell carcinoma of the oral cav ity. Study Design: Retrospective study of 137 patients with T4 squamous cel l carcinoma of the oral cavity treated by surgery and radiotherapy (84 NO, 23 N1, 16 N2, 14 N3), Twenty-three patients in the NO group had a history o f surgery or radiotherapy. One hundred fourteen patients underwent Limited or radical neck dissection unilaterally or bilaterally. Methods: The histol ogical charts were reviewed and correlated with preoperative lymph node cli nical stage. The local failure rate and the overall survival curves were ca lculated with respect to clinical and histological stages, The causes of de ath were analyzed. Results: No evidence of lymph node metastasis was found in 47.4% of cases (54 of 114 patients). Among the node-positive (NS) patien ts, 39 had rupture of the lymph node capsule (R+), In the NO group, 27.8% o f patients were N+. Regional control rates after surgery and radiotherapy w ere 95% at 1 year and 85.4% at 5 years. The local failure rates were 6% in NO, 8.7% in N1, 31.2% in N2, 51.7% in N3, 9% in node-negative (N-), and 29% in N+R+ patients, The overall survival rates at 3 and 5 years were, respec tively, 44.7% and 34.8% in the NO group, 37.7% and 37.7% (same rate at 3 an d 5 years) in the N1 group, and 31.2% and 15.8% in the N2 group. None of th e patients in the N3 group survived beyond 2 years. The overall survival ra tes at 5 years were 42.8% and 17.5% in the N- and N+ groups, respectively. Conclusions: In patients with locally advanced tumors (T4), clinical nodal status and histological nodal invasion were key prognostic factors. The pre sence of occult metastases in the NO group justifies routine neck dissectio n.