A prospective study to evaluate the impact and independency of depth of invasion in comparison with other clinicopathologic prognostic variables in oral cavity malignancy

Authors

  • Subbiah Shanmugam Department of Surgical Oncology, Kilpauk Medical College, Chennai, Tamil Nadu, India
  • Gopu Govindasamy Department of Surgical Oncology, Kilpauk Medical College, Chennai, Tamil Nadu, Indi
  • X. Gerald Anand Raja Department of Surgical Oncology, Kilpauk Medical College, Chennai, Tamil Nadu, Indi

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20200149

Keywords:

Depth of invasion, Close margin, Lymph node incidence, Oral cavity

Abstract

Background: Depth of invasion is included in the staging of oral cavity malignancies in the recent 8th edition of American Joint Committee on Cancer or tumour, node and metastasis staging system. This study analyses the impact of diffuse optical imaging (DOI) on incidence of lymph node involvement, stage migration, postoperative margin and independency.

Methods: Postoperative HPE of fifty patients with oral cavity malignancy operated in our institute from January 2018 were collected. Depth of invasion and other pathological parameters were documented. DOI divided into three groups and statistical analysis done.  

Results: No lymph node metastasis is found in superficial tumours, 43% of intermediate thickness and 76% of deep tumours had lymph node involvement. Positive margin is seen only in patients with tumour DOI more than 0.5 cm, more than 50% of deep tumours had close margins while 75% of superficial tumours had adequate margin. Out of the 24 T3 tumours in this study 13 were upstaged due to inclusion of DOI, which would have been T2 according to the previous staging system. There is 54.1% (13 out of 24) upstaging in T3 tumours (T2 to T3), 23% (3 out of 13) in T2 (T1 to T2). There is no significant correlation between DOI and anatomical site, tumour size, tumour thickness, lymphovascular invasion and grade.

Conclusions: Depth of invasion in oral cavity malignancies impacts adversely lymph node metastasis and margin status. It is an independent prognostic factor in oral cavity malignancy.

References

Lydiatt WM, Patel SG, Ridge JA, Sullivan BO, Shah JP, Ridge JA, et al. AJCC cancer staging manual. CA Cancer J Clin. 2017;67(2):122-37.

Spiro RH, Huvos AG, Wong GY, Spiro JD, Gnecco CA, Strong EW et al. Predictive value of tumor thickness in squamous carcinoma confined to the tongue and floor of the mouth. Am J Surg. 1986;152:345-50.

Moore C, Kuhns JG, Greenberg RA. Thickness as prognostic aid in upper aerodigestive tract cancer. Arch Surg. 1986;121:1410-4.

Byers RM, El-Naggar AK, Lee YY, Rao B, Fornage B, Terry NH, et al. Can we detect or predict the presence of occult nodal metastases in patients with squamous carcinoma of the oral tongue? Head Neck. 1998;20:138-44.

Tarsitano A, Corso GD, Tardio ML, Marchetti C. Tumor Infiltration Depth as Predictor of Nodal Metastasis in Early Tongue Squamous Cell Carcinoma. J Oral Maxillofac Surg. 2016;74(3):523-7.

Ding D, Stokes W, Eguchi M, Hararah M, Sumner W, Amini A, et al. Association Between Lymph Node Ratio and Recurrence and Survival Outcomes in Patients With Oral Cavity Cancer. JAMA Otolaryngol Head Neck Surg. 2019;145(1):53-61.

Payne KFB. Factors Influencing the Status of the Surgical Margin in the Resection of Oral Squamous Cell Carcinoma. Biomed J Sci Tech Res. 2017;1(7):1835-8.

Dirvena R, Ebrahimia A, Moeckelmanna N, Palmea CE, Guptaa R, Clark J. Tumor thickness versus depth of invasion - Analysis of the 8th edition American Joint Committee on Cancer Staging for oral cancer, Oral Oncol. 2017;74:30-3.

Lawaetz M, Homøe P. Risk factors for and consequences of inadequate surgical margins in oral squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;118(6):642-6.

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Published

2020-01-24

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Section

Original Research Articles