Elsevier

Oral Oncology

Volume 50, Issue 11, November 2014, Pages 1081-1088
Oral Oncology

Risk factors and treatment of contralateral neck recurrence for unilateral oral squamous cell carcinoma: A retrospective study of 1482 cases

https://doi.org/10.1016/j.oraloncology.2014.08.003Get rights and content

Summary

Background

The aim of this study was to describe risk factors of contralateral neck recurrence (CLNR) and to identify its high-risk population after treatment for unilateral oral squamous cell carcinoma.

Methods

Between June 1991 and June 2012, a total of 1482 eligible patients who were treated with radical surgery with or without adjuvant therapy were retrospectively reviewed.

Results

The outcome assessment parameters were the rate of 5-year CLNR and the rate of disease-specific survival (DSS). In the entire study cohort, the 5-year CLNR rate was 4.1%. In a multivariate analysis, only extracapsular spread (ECS) status (hazard ratio [HR]: 12.978, 95% confidence interval [CI]: 1.328–126.829, P = 0.028) was an independent risk factor for 5-year CLNR. In addition, 5-year CLNR (HR: 36.410, 95% CI: 7.093–186.914, P < 0.001), T stage (HR: 3.475, 95% CI: 1.151–10.488, P = 0.027) and growth pattern (HR: 4.831, 95% CI: 1.776–13.140, P = 0.002) were independent risk factors for 5-year DSS. Patients with at least two risk factors were identified as a high-risk population for CLNR; these patients also had a poor prognosis. Elective contralateral neck dissection (ND) plus concurrent chemoradiotherapy (CCRT) can improve the 5-year DSS in these high-risk patients, but it does not decrease the 5-year CLNR rate.

Conclusion

For low- and moderate-risk patients, contralateral neck observation should be considered sufficient if strict compliance with a cancer surveillance protocol is followed. However, whether high-risk patients benefit from contralateral ND plus adjuvant CCRT can only be answered in a prospective trial.

Introduction

Contralateral neck metastases are uncommon in patients with oral squamous cell carcinoma (OSCC) at the time of diagnosis. Currently, few large studies on the association between clinicopathologic factors and the development of contralateral neck recurrence (CLNR) after surgical resection of primary OSCC are available [1]. However, the prognosis of patients with OSCC and neck lymph node recurrence remains dismal, especially in cases of contralateral recurrence [1], [2], [3]. Several clinical and pathologic risk factors have been proposed in OSCC, including primary site, extension, clinical stage, pathologic grade, tumour thickness, and perineural invasion [4], [5], [6]. A recent study, performed in an area with high rates of betel quid chewing and based on a treatment design that did not account for the possibility of lymphatic drainage crossing the midline, showed that patients with local recurrence have a higher incidence of CLNR than those without [7]. In terms of treatment decision-making, the use of elective contralateral neck dissection (ND) remains controversial for patients with OSCC that does not cross the midline [7].There have been no comprehensive studies on the rate of CLNR or on the risk factors and principles of combined treatment for unilateral OSCC in patients from a non-betel quid chewing area.

The aim of this retrospective investigation was to identify significant predictors for CLNR in a large cohort of patients with OSCC who were recruited in an area of Northern China where betel nut is not commonly chewed. All patients in this study were treated with radical surgery, either with or without radiotherapy (RT) or concurrent chemoradiotherapy (CCRT). This study can first clarify the rate of CLNR in patients with OSCC in Northern China, which has a population of more than 600 million people, accounting for approximately half of the Chinese population. Second, it may show whether contralateral ND and adjuvant treatment can improve the clinical outcome of patients with OSCC by reducing the risk of CLNR. Finally, the prognostic scoring of risk factors in the whole cohort may allow the identification of high-risk OSCC patients who may require more intensive therapy.

Section snippets

Patients

The Institutional Review Board (IRB) of the Stomatological Hospital of Peking University approved this study. Due to the retrospective nature of this study, it was granted an exemption by the IRB. The eligibility criteria were as follows: (1) histological diagnosis of OSCC; (2) no previous treatment; (3) no evidence of preoperative contralateral nodal metastasis; and (4) a primary tumour without evidence of distant metastasis. Exclusion criteria included the presence of midline lesions,

Patients

Between May 1991 and May 2012, a total of 2180 consecutive patients with previously untreated OSCC were scheduled for radical surgery in our hospital. A total of 698 patients were excluded due to the presence of midline lesions, bilateral lesions, or second metachronous malignancies. A total of 1482 patients were eligible for the final analysis. The final cohort included 822 (55.5%) males and 660 (45.5%) females. The median age was 60 years (range, 5–90 years). The primary tumour sites were the

Discussion

Contralateral neck lymph nodes are occasionally involved in OSCC, but such cases have an extremely poor prognosis [3], [8]. Traditionally, elective contralateral ND is generally recommended only when the tumour crosses the midline [9], [10]. To our knowledge, there have been few large studies on the prognostic factors specific for CLNR in relation to carcinoma that originates in the lateral aspect of the oral cavity. González-García et al. [11] reported an incidence rate of 5.7% for CLNR, which

Conclusion

CLNR is an independent predictor for the long-term survival of patients with OSCC. In low- and moderate-risk patients (score 0 or 1), contralateral neck observation should be considered sufficient if strict compliance with a cancer surveillance protocol is followed. However, whether high-risk patients (score  2) benefit from contralateral ND prior to adjuvant CCRT can only be determined in a prospective trial.

Conflict of interest statement

None declared.

Acknowledgements

This work was supported by the National Natural Science Foundation of China (81302350), Beijing Municipal Natural Science Foundation (7144258), China Postdoctoral Science Foundation funded project (2014T70018) and National High Technology Research and Development Program of China (2009AA045201).

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