The impact of lymphovascular invasion on survival in oral carcinoma
Introduction
In the search for prognostic factors in oral carcinoma many variables have been identified and can broadly be placed in the categories of tumour related, patient related and treatment related factors.1
Prognosis in oral cancer is largely determined by tumour related factors. The tumour-node-metastasis (TNM) system of cancer classification recognises this fact.2 However, this staging system does not incorporate histopathological factors at a time when they are increasingly recognised as being significant to prognosis.
The study aim was to relate histopathological features of primary oral carcinomas and neck dissection specimens to survival in oral carcinoma.
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Materials and methods
The management principle of the two units from which the data for this study were sourced is identical. All operable patients with primary intraoral carcinomas are treated with surgery and concomitant neck dissection. Adjuvant radiotherapy is prescribed on pathological analysis of the surgical specimens, if there is evidence of close margins at the primary site (<5 mm), greater than one node positive, extracapsular spread or bulky metastatic disease in the neck dissection specimens.
Seventy-two
Statistical methods
The Cox regression method was used to investigate the effect of several variables at any given time. A forward stepwise Cox regression was performed for analysis of multiple variables which may have a prognostic impact on survival in this cohort of patients. Initial screening for prognostic variables was done by univariate analysis. Variables shown on univariate analysis to be prognostically statistically significant were entered into a multivariate analysis by the Cox proportional hazards
Outcome
There were ten local recurrences during the observation period, (14%) of whole group. Of the ten local recurrences, six were in the floor of mouth, two in the buccal mucosa, one in the left lateral tongue region and one in the hard palate Local recurrence occurred between a range of 68 and 1925 days (Mean 517 days). Consequently, 79% of all local recurrences presented clinically within 24 months of primary surgical treatment. There were 14 nodal recurrences (19%) of whole group. Nodal
Discussion
The natural history of tumours and the three key events which characterise malignancy are reflected in the TNM system.3 These are T is the ability to grow and locally invade, N is the ability to metastasize to regional draining lymphatics, and M is the ability to metastasize to distant sites.2
In relation to oral cavity tumours these three criteria are independent indicators of prognosis although they are intimately inter-related. Increasing size by T stage leads to an increase in the rate of
Conflict of Interest Statement
None declared.
References (30)
- et al.
The hallmarks of cancer
Cell
(2000) - et al.
Impact of lymph node metastasis on the pattern of failure and survival in oral carcinomas
Am J Surg
(2003) - et al.
Lymph node status combined with lymphovascular invasion creates a more powerful tool for predicting outcome in patients with invasive breast cancer
Am J Surg
(2002) - et al.
Correlation between prognosis and degree of lymph node involvement in carcinoma of the oral cavity
Am J Surg
(1977) - et al.
Changing trends in the management of squamous carcinoma of the tongue
Am J Surg
(1984) - et al.
Cervical lymph node metastasis in oral cancer: the importance of even microscopic extracapsular spread
Oral Oncol
(2003) - et al.
Survival and patterns of recurrence in 200 oral cancer patients treated by radical surgery and neck dissection
Oral Oncol
(1999) - et al.
Recurrent carcinoma of the head and neck: treatment strategies and survival analysis in a 20-year period
Oral Oncol
(2004) - et al.
Improved survival in the treatment of squamous carcinoma of the oral tongue
Am J Surg
(1993) - et al.
Trends of oral and oropharyngeal cancer survival over five decades in 3267 patients treated in a single institution
Oral Oncol
(2004)
Tongue cancer: Is there a difference in survival compared with other subsites in the oral cavity?
J Oral Maxillofac Surg
Factors affecting survival in patients with oral cancer: an Australian perspective
Int J Oral Maxillofac Surg
Prognostic value of clinicopathological parameters in head and neck squamous cell carcinoma: a prospective analysis
Brit J Cancer
Distribution of cervical lymph node metastases from squamous cell carcinoma of the upper respiratory and digestive tracts
Cancer
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