Analysis of the rule of occult lymphatic metastasis and its related factors in clinical T1-2N0M0 oral squamous carcinoma

doi:10.3877/cma.j.issn.1674-1366.2015.02.007

Abstract

Abstract:

Objective

The aim of the study was to investigate the rule of occult lymphatic metastasis (OLM) in clinical T_1-2N₀M₀ oral squamous cell carcinoma (OSCC) and its related factors to provide clinical bases for the neck management.

Methods

This retrospective study included 232 consecutive clinical T_1-2N₀M₀ OSCC patients between January 2000 and June 2011. We explored the law of OLM according to the distribution of occult nodes. Log-rank method and Cox proportional hazard regression model were used to analyze the prognosis of patients with or without OLM and Kaplan-Meier method was used to describe their survival curves. Univariate statistical analysis (χ² method) was performed to analyze the factors predicting OLM, multivariate logistical regression analysis was then undertaken.

Results

There were 46 patients with OLM in 232 cases with cT_1-2N₀M₀ OSCC. OLM was found mainly in level Ⅱ (42.9%) , secondly in level Ⅰ (31.7%) , thirdly in level Ⅲ (19.0%) . Cox multivariate analysis identified OLM as the only independent predictive factor of survival. Its 5-year overall survival (OS) , disease-specific survival (DSS) and recurrence-free survival (RFS) rates were 63.0%, 73.9% and 56.5%, which were significantly lower than patients without OLM (χ^2OS = 45.0, χ²_DSS = 31.2, χ²_RFS = 58.6, P-values were all< 0.05) . Univariate analysis showed that the degree of invasion, occurrence time and tumor growth pattern were the significant factors of OLM. Multivariate logistic regression analysis showed that the degree of invasion (Wald = 13.0, P = 0.001) and occurrence time (Wald = 7.9, P = 0.049) were the close related factors of OLM. Among these factors, muscular invasion and over one year occurrence time were the predictive factors of OLM, their OR value were 6.0 and 4.6, respectively.

Conclusion

The OLM of cT_1-2N₀M₀ OSCC mainly distribute in level Ⅰ, Ⅱ and Ⅲ. For clinical T_1-2N₀M₀ OSCC patients, elective neck dissection might be taken into consideration when the tumor lasts for more than 6 months or invades muscular layer, which are easily lead to OLM.

Key words: Mouth neoplasms, Carcinoma, squamous cell, Lymphatic metastasis, occult, Neck dissection, Prognosis

Xiangqi Liu, Yujie Liang, Guangsen Zheng, Xiaomei Lao, Sien Zhang, Kan Li, Guiqing Liao. Analysis of the rule of occult lymphatic metastasis and its related factors in clinical T_1-2N₀M₀ oral squamous carcinoma[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2015, 09(02): 123-128.

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URL: https://zhkqyxyjzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-1366.2015.02.007

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References 25

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淋巴结分布	转移病例数	区转移数
Ⅰ	15	15
Ⅱ	17	17
Ⅰ+Ⅱ	1	2
Ⅲ	2	2
Ⅰ+Ⅲ	1	2
Ⅱ+Ⅲ	4	8
Ⅰ+Ⅱ+Ⅲ	3	9
Ⅳ	0	0
Ⅲ+Ⅳ	1	2
Ⅱ+对侧Ⅰ	1	2
Ⅱ+Ⅲ+对侧（Ⅰ+Ⅱ）	1	4
合计	46	63

淋巴结分布	转移病例数	区转移数
Ⅰ	15	15
Ⅱ	17	17
Ⅰ+Ⅱ	1	2
Ⅲ	2	2
Ⅰ+Ⅲ	1	2
Ⅱ+Ⅲ	4	8
Ⅰ+Ⅱ+Ⅲ	3	9
Ⅳ	0	0
Ⅲ+Ⅳ	1	2
Ⅱ+对侧Ⅰ	1	2
Ⅱ+Ⅲ+对侧（Ⅰ+Ⅱ）	1	4
合计	46	63

变量	OS		DSS		RFS
变量	HR(95%CI)	P值	HR(95%CI)	P值	HR(95%CI)	P值
无OLM	参考	<0.001	参考	<0.001	参考	<0.001
有OLM	9.6(4.3～21.5)	?	9.8(3.7～26.0)	?	10.8(5.0～23.1)	?

变量	OS		DSS		RFS
变量	HR(95%CI)	P值	HR(95%CI)	P值	HR(95%CI)	P值
无OLM	参考	<0.001	参考	<0.001	参考	<0.001
有OLM	9.6(4.3～21.5)	?	9.8(3.7～26.0)	?	10.8(5.0～23.1)	?

临床病理资料		病例数	OLM病例数	P值
年龄(岁)	< 60	127	25	0.952
年龄(岁)	≥60	105	21	0.952
性别	男	123	20	0.148
性别	女	109	26	0.148
吸烟史	有	49	5	0.057
吸烟史	无	183	41	0.057
嗜酒史	有	22	3	0.581
嗜酒史	无	210	43	0.581
肿瘤部位	舌	170	36	0.816
	颊黏膜	25	5
	口底	18	3
	下牙龈	19	2
临床T分期	cT₁	95	15	0.199
临床T分期	cT₂	137	31	0.199
生长方式	溃疡型	73	19	0.013
	浸润型	86	20
	外生型	73	6
分化程度	低	12	3	0.739
	中	58	13
	高	162	30
浸润程度	黏膜层	55	4	0.001
	黏膜下层	84	13
	肌层	93	29
生长时间（月）	> 0,≤6	140	26	0.043
	> 6,≤12	30	11
	> 12,≤24	8	6
	> 24	8	3

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相关因素		P值	OR值	95% CI
生长方式	外生型	?	参考	?
	溃疡型	> 0.05	?	?
	浸润型	> 0.05	?	?
浸润程度	黏膜层	?	参考	?
	黏膜下层	> 0.05	?	?
	肌层	0.002	6.0	1.9 ~ 18.4
生长时间	> 0,≤6	?	参考	?
	> 6,≤12	> 0.05	?	?
	> 12,≤24	0.012	4.6	1.4 ~ 15.6
	> 24	> 0.05	?	?

相关因素		P值	OR值	95% CI
生长方式	外生型	?	参考	?
	溃疡型	> 0.05	?	?
	浸润型	> 0.05	?	?
浸润程度	黏膜层	?	参考	?
	黏膜下层	> 0.05	?	?
	肌层	0.002	6.0	1.9 ~ 18.4
生长时间	> 0,≤6	?	参考	?
	> 6,≤12	> 0.05	?	?
	> 12,≤24	0.012	4.6	1.4 ~ 15.6
	> 24	> 0.05	?	?

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