Scientific paper
A comparison of the prognostic significance of tumor diameter, length, width, thickness, area, volume, and clinicopathological features of oral tongue carcinoma

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Abstract

Background: The present study aims at evaluation of the prognostic value of tumor size including diameter, length, thickness, width, area, and volume in the prediction of nodal metastasis, local recurrence, and survival of oral tongue carcinoma. The results will have important implications for the management of patients.

Methods: Eighty-five glossectomy specimens of oral tongue carcinoma were serially sectioned in 3 mm thickness for the tumor size evaluation with computer image analyzer.

Results: Among all the tumor size parameters being evaluated, tumor thickness was the only significant factor for the prediction of local recurrence, nodal metastasis, and survival. With the use of 3 mm and 9 mm division, tumor of up to 3 mm thickness has 10% nodal metastasis, 0% local recurrence, and 100% 5-year actuarial disease-free survival; tumor thickness of more than 3 mm and up to 9 mm has 50% nodal metastasis, 11% local recurrence, and 77% 5-year actuarial disease free survival; tumor of more than 9 mm has 65% nodal metastasis, 26% local recurrence, and 60% 5-year actuarial disease-free survival.

Conclusions: Tumor thickness should be considered in the management of patients with oral tongue carcinoma.

Section snippets

Patients and methods

Patients with squamous cell carcinoma of oral tongue who had glossectomy treatment from 1987 to 1998 were recruited in the present prospective study. Patients with carcinoma of tongue base, other sites of oral cavity, or T4 stage were all excluded. Patients with excision biopsy prior to glossectomy were excluded because the tumor size could not be measured in the glossectomy specimen. One patient who died of the postoperative immediate complication of chest infection was also excluded because

Results

Nodal metastasis was present in 43 (51%) patients including 30 patients who had pathological evidence of nodal metastasis in the neck dissection specimens (9 therapeutic neck dissections for clinically N+ neck and 21 neck dissections for cN0 neck, 6 of them also had regional recurrences after neck dissections) and 13 patients who had nodal recurrences not associated with local recurrence (11 cN0 without elective neck dissection and 2 contralateral neck of pN0 patients after elective ipsilateral

Comments

Carcinoma of oral tongue is known to have high incidence of nodal metastasis even in the early T1 and T2 stages.12, 13 Nodal metastasis is in fact the most common site of recurrence and treatment failure of tongue carcinoma. The prognostic significance of tumor thickness in head and neck carcinomas had been reported consistently in the literature.3, 4, 5, 6, 7, 8, 9 Tumor diameter and T-staging were consistently found to be not significant prognostic factors in most reports.3, 4, 5, 6, 7, 8, 9

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This study was supported by a research grant from the University of Hong Kong.

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