Nodal Disease and Survival in Oral Cancer: Is Occult Metastasis a Burden Factor Compared to Preoperatively Nodal Positive Neck?

The impact of neck involvement and occult metastasis (OM) in patients with oral squamous cell carcinoma (OSCC) favors an elective neck dissection. However, there are barely any existing data on survival for patients with OM compared with patients with positive lymph nodes detected preoperatively. Th...

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Main Authors: Selgai Haidari, Katharina Theresa Obermeier, Moritz Kraus, Sven Otto, Florian Andreas Probst, Paris Liokatis
Format: Article
Language:English
Published: MDPI AG 2022-08-01
Series:Cancers
Subjects:
Online Access:https://www.mdpi.com/2072-6694/14/17/4241
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author Selgai Haidari
Katharina Theresa Obermeier
Moritz Kraus
Sven Otto
Florian Andreas Probst
Paris Liokatis
author_facet Selgai Haidari
Katharina Theresa Obermeier
Moritz Kraus
Sven Otto
Florian Andreas Probst
Paris Liokatis
author_sort Selgai Haidari
collection DOAJ
description The impact of neck involvement and occult metastasis (OM) in patients with oral squamous cell carcinoma (OSCC) favors an elective neck dissection. However, there are barely any existing data on survival for patients with OM compared with patients with positive lymph nodes detected preoperatively. This study aims to compare survival curves of patients suffering from lymph nodal metastases in a preoperatively N+ neck with those suffering from OM. In addition, clinical characteristics of the primary tumor were analyzed to predict occult nodal disease. This retrospective cohort study includes patients with an OSCC treated surgically with R0 resection with or without adjuvant chemoradiotherapy between 2010 and 2016. Minimum follow-up was 60 months. Kaplan–Meier analysis was used to compare the survival between patients with and without occult metastases and patients with N+ neck to those with occult metastases. Logistic regression was used to detect potential risk factors for occult metastases. The patient cohort consisted of 226 patients. Occult metastases occurred in 16 of 226 patients. In 53 of 226 patients, neck lymph nodes were described as suspect on CT imaging but had a pN0 neck. Higher tumor grading increased the chance of occurrence of occult metastasis 2.7-fold (OR = 2.68, 95% CI: 1.07–6.7). After 12, 24, 48 and 60 months, 82.3%, 73.8%, 69% and 67% of the N0 patients, respectively, were progression free. In the group with OM occurrence, for the same periods 66.6%, 50%, 33.3% and 33.3% of the patients, respectively, were free of disease. For the same periods, respectively, 81%, 63%, 47% and 43% of the patients in the N+ group but without OM remained disease free. The predictors for progression-free survival were a positive N status (HR = 1.44, 95% CI: 1.08–1.93) and the occurrence of OM (HR = 2.33, 95% CI: 1.17–4.64). The presence of occult metastasis could lead to decreased survival and could be a burdening factor requiring treatment escalation and a more aggressive follow-up than nodal disease detected in the preoperative diagnostic imaging.
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spelling doaj.art-f6fc890510534a49bf0a6353aec5f1552023-11-23T12:52:11ZengMDPI AGCancers2072-66942022-08-011417424110.3390/cancers14174241Nodal Disease and Survival in Oral Cancer: Is Occult Metastasis a Burden Factor Compared to Preoperatively Nodal Positive Neck?Selgai Haidari0Katharina Theresa Obermeier1Moritz Kraus2Sven Otto3Florian Andreas Probst4Paris Liokatis5Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, 80337 Munich, GermanyDepartment of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, 80337 Munich, GermanyDepartment of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich, University Hospital LMU Munich, 80337 Munich, GermanyDepartment of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, 80337 Munich, GermanyDepartment of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, 80337 Munich, GermanyDepartment of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, 80337 Munich, GermanyThe impact of neck involvement and occult metastasis (OM) in patients with oral squamous cell carcinoma (OSCC) favors an elective neck dissection. However, there are barely any existing data on survival for patients with OM compared with patients with positive lymph nodes detected preoperatively. This study aims to compare survival curves of patients suffering from lymph nodal metastases in a preoperatively N+ neck with those suffering from OM. In addition, clinical characteristics of the primary tumor were analyzed to predict occult nodal disease. This retrospective cohort study includes patients with an OSCC treated surgically with R0 resection with or without adjuvant chemoradiotherapy between 2010 and 2016. Minimum follow-up was 60 months. Kaplan–Meier analysis was used to compare the survival between patients with and without occult metastases and patients with N+ neck to those with occult metastases. Logistic regression was used to detect potential risk factors for occult metastases. The patient cohort consisted of 226 patients. Occult metastases occurred in 16 of 226 patients. In 53 of 226 patients, neck lymph nodes were described as suspect on CT imaging but had a pN0 neck. Higher tumor grading increased the chance of occurrence of occult metastasis 2.7-fold (OR = 2.68, 95% CI: 1.07–6.7). After 12, 24, 48 and 60 months, 82.3%, 73.8%, 69% and 67% of the N0 patients, respectively, were progression free. In the group with OM occurrence, for the same periods 66.6%, 50%, 33.3% and 33.3% of the patients, respectively, were free of disease. For the same periods, respectively, 81%, 63%, 47% and 43% of the patients in the N+ group but without OM remained disease free. The predictors for progression-free survival were a positive N status (HR = 1.44, 95% CI: 1.08–1.93) and the occurrence of OM (HR = 2.33, 95% CI: 1.17–4.64). The presence of occult metastasis could lead to decreased survival and could be a burdening factor requiring treatment escalation and a more aggressive follow-up than nodal disease detected in the preoperative diagnostic imaging.https://www.mdpi.com/2072-6694/14/17/4241occult metastasesneck dissectionsurvivaloral squamous cell carcinoma
spellingShingle Selgai Haidari
Katharina Theresa Obermeier
Moritz Kraus
Sven Otto
Florian Andreas Probst
Paris Liokatis
Nodal Disease and Survival in Oral Cancer: Is Occult Metastasis a Burden Factor Compared to Preoperatively Nodal Positive Neck?
Cancers
occult metastases
neck dissection
survival
oral squamous cell carcinoma
title Nodal Disease and Survival in Oral Cancer: Is Occult Metastasis a Burden Factor Compared to Preoperatively Nodal Positive Neck?
title_full Nodal Disease and Survival in Oral Cancer: Is Occult Metastasis a Burden Factor Compared to Preoperatively Nodal Positive Neck?
title_fullStr Nodal Disease and Survival in Oral Cancer: Is Occult Metastasis a Burden Factor Compared to Preoperatively Nodal Positive Neck?
title_full_unstemmed Nodal Disease and Survival in Oral Cancer: Is Occult Metastasis a Burden Factor Compared to Preoperatively Nodal Positive Neck?
title_short Nodal Disease and Survival in Oral Cancer: Is Occult Metastasis a Burden Factor Compared to Preoperatively Nodal Positive Neck?
title_sort nodal disease and survival in oral cancer is occult metastasis a burden factor compared to preoperatively nodal positive neck
topic occult metastases
neck dissection
survival
oral squamous cell carcinoma
url https://www.mdpi.com/2072-6694/14/17/4241
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