Management of contralateral N0 neck in oral cavity squamous cell carcinoma

BACKGROUND: The purpose of this study was to evaluate the incidence and predictive factors of contralateral occult lymph node metastasis in squamous cell carcinomas of the oral cavity to form a rational basis for elective contralateral neck management. METHODS: We performed a retrospective analysis of 66 patients with cancer of the N0-2 oral cavity undergoing elective neck dissection for contralateral clinically negative necks from 1991 to 2003. RESULTS: Clinically negative but pathologically positive contralateral lymph nodes occurred in 11% (7 of 66). Of the 11 cases with a clinically positive ipsilateral node neck, contralateral occult lymph node metastases developed in 36% (4 of 11), in contrast with 5% (3 of 55) in the cases with clinically N0 ipsilateral necks (p < .05). Based on the clinical staging of the tumor, 8% (3 of 37) of the cases showed lymph node metastases in T2 tumors, 25% (2 of 8) in T3, and 18% (2 of 11) in T4. None of the T1 tumors (10 cases) had pathologically positive lymph nodes. The rate of contralateral occult neck metastasis was significantly higher in advanced-stage cases and those crossing the midline, compared with early-stage or unilateral lesions (p < .05). Patients with no evidence of contralateral nodal cancer had significantly improved disease-specific survival over patients with any pathologically positive nodes (5-year disease-specific survival rate was 79% vs. 43%, p < .05). CONCLUSIONS: The risk of contralateral occult neck involvement in the oral cavity squamous cell carcinomas above the T3 classification or those crossing the midline with unilateral metastases was high, and patients who presented with a contralateral metastatic neck had a worse prognosis than those whose disease was staged as N0. Therefore, we advocate an elective contralateral neck treatment with surgery or radiotherapy in patients with oral cavity squamous cell carcinoma with ipsilateral node metastases or tumors, or both, whose disease is greater than T3 or crossing the midline.     

Pulmonary Metastasectomy for Head and Neck Cancers

Background: Distant metastases from carcinomas that arise from the head and neck region are infrequent. The most common site is the lung. To evaluate the results of resection of pulmonary metastases for head and neck cancers, we reviewed our own cases of these metastases.Methods: Between November 1966 and March 1995, 83 patients with pulmonary metastases from head and neck cancers underwent 94 thoracic operations. All patients had obtained or had obtainable locoregional control of their primary head and neck cancers. Kaplan-Meier and Cox regression models were used to analyze the prognostic factors for survival after metastasectomy.Results: Median age was 53 years (range, 17–77). Fifty-nine were male and 24 were female. Forty-one patients had squamous cell cancers, and 36 had glandular tumors that consisted mostly of thyroid and adenoid cystic carcinomas. The median disease-free interval from the time of treatment of the head and neck primary cancers to the development of pulmonary metastases was 27 months. Sixty-eight (82%) patients had complete resection. Overall operative mortality rate was 2%. Overall actuarial survival rate after metastasectomy was 50% at 5 years. Patients with glandular tumors had a 5-year survival rate of 64% compared with 34% for patients with squamous cell cancers. When the patients with glandular tumors were analyzed according to their histology, patients with adenoid cystic carcinomas had an 84% 5-year survival, but none remained disease-free. Patients with thyroid cancers fared similarly whether they were treated medically or surgically. On multivariate analysis, the adverse prognostic factors for patients with squamous cell cancers were incomplete resection, age greater than 50 years, and disease-free interval less than or equal to 2 years.Conclusions: Approximately 30% of patients with pulmonary metastases from squamous cell cancers of the head and neck who underwent complete resection of all their metastases can expect to achieve long-term survival. The role of pulmonary resection for patients with glandular tumors is unclear.Presented in part at the 51st Annual Symposium Meeting of the Society of Surgical Oncology, San Diego, March 26–29, 1998.     

Predictive value of p53 and PCNA expression for occult neck metastases in patients with clinically node-negative oral tongue cancer

OBJECTIVE: In an attempt to identify molecular markers predictive of occult neck metastases, we investigated whether positive p53 or proliferating cell nuclear antigen (PCNA) immunoreactivities on deparaffinized sections of the primary tumor are correlated to the presence of occult neck node metastases in oral tongue cancer patients with clinically negative cervical nodes (N0). STUDY DESIGN AND SETTING: Between 1986 and 1997, 37 clinically N0 patients who underwent neck dissection (25 male, 12 female; mean age 54 years) were selected for p53 and PCNA staining. RESULTS: p53 and PCNA immunoreactivities were detected in 68% and 32%, respectively. There was no correlation between p53 or PCNA and other clinicopathological factors, such as tumor differentiation, tumor type, tumor size, and T-stage. Although tumor differentiation (P=0.03) and tumor size (P=0.03) were significantly correlated with occult neck metastases of oral tongue cancer by univariate analysis, no correlation was found between p53 or PCNA and the presence of occult neck metastasis. CONCLUSION: p53 and/or PCNA expression are unsuitable as biological markers predictive of lymph node metastases of oral tongue cancer. SIGNIFICANCE: p53- or PCNA-positive status are not a reliable parameter for selection of elective neck dissection in the management of N0 oral tongue cancer patients.     

Patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract

A consecutive series of 1,081 previously untreated patients undergoing 1,119 radical neck dissections (RNDs) for squamous carcinoma of the head and neck was reviewed to study the patterns of nodal metastases. Primary tumors were located in the oral cavity in 501 patients, in the oropharynx in 207 patients, in the hypopharynx in 126 patients, and in the larynx in 247 patients. Lymph node metastases were confirmed histologically in 82% of 776 therapeutic neck dissections, and micrometastases were discovered in 33% of 343 elective RNDs. Lymph node groups in the neck were described by levels (I to V). Predominance of certain levels was seen for each primary site. Levels I, II, and III were at highest risk for metastasis from cancer of the oral cavity, and levels II, III, and IV were at highest risk for metastasis from carcinomas of the oropharynx, hypopharynx, and larynx. Supramohyoid neck dissection (clearing levels I, II, and III) for NO patients with primary squamous cell carcinomas of the oral cavity and anterolateral neck dissection (clearing levels II, III, and IV) for NO patients with primary squamous cell carcinomas of the oropharynx, hypopharynx, and larynx are recommended.     

Prognostische Aussagen zum Mundhöhlenkarzinom

The aim of the present study was to analyze different prognostic factors to calculate the overall survival in oral squamous cell carcinoma (OSCC). Samples retrospectively collected from 99 patients with primary OSCC were analyzed with regard to tumor node metastasis stage, grading, and 5-year survival time and summarized at an SPSS 11.0 databank. Treated were 72 men and 27 women (average age 59 years) due to oral squamous cell carcinoma. A general 5-year survival time of 57.3% was found. Patient survival depended on tumor size and the extent of lymph node metastasis: survival was 80.1% (n=23) for T1 tumors and only 16.2% (n=28) for T4 tumors, 68.7% (n=55) at the N0 stage and 42.8% at >N0 (n=44, χ² test P=0.01, Fischer’s exact test P=0.014). Highly differentiated carcinomas (n=26) had a survival probability of 78.9% and G2 and G3 tumors of only 48.9% (n=73, χ² test P<0.001). Tumor size and lymph node metastases are decisive.     

Prognostic value of carbonic anhydrase IX expression in penile squamous cell carcinoma: A pilot study

ObjectivesTo determine whether carbonic anhydrase IX (CA IX) has prognostic value of lymph node metastases and cancer-specific survival in penile squamous cell carcinoma treated with surgery.Materials and methodsCA IX expression was detected in the primary disease of 73 penile cancer patients using the method of immunohistochemistry. The expression levels of CA IX were categorized into 2 groups according to the cutoff of 10% of positively stained tumor cells. Associations between CA IX expression and clinicopathologic characteristics, immunoreactivity of p53 and Ki-67, and outcomes were analyzed.ResultsHigh CA IX expression was observed in 31 (42.5%) of cases. CA IX expression was not associated with patient age, T stage, grade, lymphovascular invasion, and Ki-67 expression, but was associated with p53 expression (P = 0.015). Both univariate and multivariate analysis failed to show CA IX expression was a statistically significant predictor of lymph node metastases and cancer-specific survival.ConclusionsImmunohistochemical expression of CA IX did not associate with lymph node metastases and cancer-specific survival in penile squamous cell carcinoma. A panel of prognostic markers that reflect the characteristic of tumor cell and organ microenvironment may be more suitable for prognostication in penile cancer.     

Squamous Cell Carcinoma of the Lower Lip and Supra-Omohyoid Neck Dissection

Purpose: The aim of this study is to evaluate our approach to patients with squamous cell carcinoma of lower lip.

Patients and methods: This study includes 31 lower lip squamous cell carcinomas followed up between 1994 and 2000. Primary treatment was applied to 28 patients of whom 23 were in stages I-II and five in stages III-IV. Three patients presented locoregional recurrence. Neck dissection was performed during primary lip resection in patients with palpable cervical lymph node involvement. Patients with unpalpable cervical lymph nodes were divided into two subgroups: one was submitted to elective neck dissection (n = 11) and the other had isolated lip resection (n = 8). Unilateral or bilateral selective supra-omohyoid neck dissection (SOHND) was performed according to the localisation of the disease. Radical dissection was performed in a secondary intervention, when SOHND revealed lymph node metastases. Radiotherapy and chemotherapy were applied for curative and/or adjuvant treatment in addition to surgery in patients with locoregional recurrence and metastatic lymph nodes or with perineural involvement.

Results: Occult cervical metastasis within a single lymph node was found in one of the 11 No patients who underwent elective neck dissection. Delayed neck metastasis developed in one of the eight patients in whom isolated lip resection (without neck exploration) was performed. Chemoradiotherapy was administered to this patient, but he died. Neck metastasis was established histologically in four of five patients in stages III-IV. Postoperative radiotherapy was used on these patients. One of the patients in this group died due to inoperable local recurrence in the neck, another died because of distant metastasis. Local mandibular recurrence was seen in one of these patients after three years. Comment: Six patients (19%) died due to lower lip carcinoma in this series. Our findings show the importance of elective neck dissection and intact surgical resection margins.     

Immunoexpression of p53 protein and proliferating cell nuclear antigen in penile carcinoma.

PURPOSE: We examined p53 protein and proliferating cell nuclear antigen immunoexpression as prognostic factors to the outcome of squamous cell carcinoma of the penis in 50 patients. MATERIALS AND METHODS: Penectomy and lymphadenectomy were performed in 14 patients with clinically positive nodes while 36 with cN0 disease were treated with penectomy and kept under surveillance that resulted in subsequent lymphadenectomy due to nodal relapse in 8. Of 21 patients with confirmed nodal metastases 18 died of disease. Immunohistochemical reactions were performed via the avidin-biotin-immunoperoxidase method and the results were compared with tumor pT stage, grade, nodal status and cause specific death. RESULTS: In univariate analysis proliferating cell nuclear antigen staining showed association only with nodal metastasis (p = 0.04) while p53 staining exhibited correlation with tumor pT stage (p = 0.0005), grade (p = 0.02), lymphatic spread (p = 0.02) and cause specific survival (p = 0.003). Multivariate analysis showed that p53 immunoreactivity was the only factor with prognostic significance for disease progression and cause specific survival. Tumor pT stage, grade and proliferating cell nuclear antigen staining had no significance for nodal metastases and cause specific death. CONCLUSIONS: Proliferating cell nuclear antigen staining had no prognostic value for disease progression. Since p53 over expression was associated with tumor progression and cause specific death, perhaps it should be evaluated in staging and therapeutic planning for patients with squamous cell carcinoma of the penis.     

p21Waf1/Cip1 Expression Is a Prognostic Marker in Curatively Resected Esophageal Squamous Cell Carcinoma, but Not p27Kip1, p53, or Rb

Background: p21Waf1/Cip1 (p21), p27Kip1 (p27), p53, and Rb play critical roles in cell cycle regulation and may influence the clinical behavior of tumors. We examined whether their expression is useful to predict survival of patients with esophageal squamous cell carcinoma (ESC).Methods: Expression of p21, p27, p53, and Rb was studied by the immunohistochemical method in specimens from 62 patients with curatively resected ESC tumors and scored by a computerized image analysis system.Results: The median expression scores of p21, p27, p53, and Rb (14, 12, 27, and 50, respectively) were used as cut-off points to define low and high expression groups for each protein. The 5-year survival rate for the high p21 expression group was 68%; that for the low expression group was 31% (P = .0062). p27, p53, and Rb were not correlated with overall survival. When patients were categorized into four groups based on p21 expression level and lymph node involvement (pN), the survival curves were significantly different (P = .0017). Thus, patients without lymph node involvement but with low p21 expression had survival similar to that of patients with lymph node involvement and high p21 expression. Multivariate analysis showed that age (P = .0102), lymph node involvement (P = .0076), and p21 (P = .0276) were independent prognostic factors.Conclusions: Expression of p21 is an independent prognostic factor in curatively resected ESC. Definition of new subgroups of patients based on p21 expression may help to enhance the stratification of stage.     

Intracranial metastases in patients with squamous cell carcinoma of the head and neck.

BACKGROUND: Intracranial metastases are rarely clinically diagnosed in patients with head and neck squamous cell carcinoma. Only 7 patients with metastases to the cavernous sinus from head and neck squamous cell carcinomas have been reported. METHODS: A retrospective study revealed 13 patients with intracranial metastases of head and neck squamous cell carcinoma. In a 53-year-old woman a cavernous sinus metastasis of a laryngeal carcinoma was histologically diagnosed by using a CT-guided surgical navigation system and was treated with stereotactic radiotherapy. RESULTS: The mean survival was 4.3 months. Predictive factors for longer survival were absence of extracranial disease, age younger than 60 years, and treatment with radiotherapy. CONCLUSIONS: The prognosis for patients with intracranial disease is poor. The current development of computer-assisted stereotactic navigation and stereotactic radiotherapy may facilitate surgical diagnostic exploration and improve treatment, especially in patients without extracranial disease.     

Clinical significance and prognostic value of apoptosis related proteins in superficial esophageal squamous cell carcinoma

Background: The purpose of the present study was to examine the expression of cell cycle regulators [p53, p21^WAF1/CIP1 (p21), and Rb] and apoptosis related proteins Bax and Bcl-X_L and to evaluate the relationship between their expressions and clinicopathological findings in patients with superficial squamous cell carcinomas of the esophagus.Methods: We immunohistochemically investigated the expression of p53, p21, Rb, Bax, and Bcl-X_L in 79 patients with superficial esophageal carcinoma.Results: p21 overexpression was found in mucosal carcinoma (P = 0.05) and a high Bcl-X_L score was observed for submucosal carcinoma (P = 0.03). The patients with high Bcl-X_L score had more frequent lymphatic invasion and lymph node metastasis than did those with low Bcl-X_L score (P < 0.05). Univariate analysis revealed significantly shorter survival in patients with high Bcl-X_L expression than in those with low Bcl-X_L expression, but Bcl-X_L expression was not identified as an independent prognostic factor by multivariate analysis.Conclusions: Because Bcl-Xl expression correlated well with depth of tumor invasion, lymphatic invasion, and lymph node metastasis, examination of Bcl-X_L expression will help to estimate the properties in superficial squamous cell carcinoma of the esophagus.     

Cervical lymph node metastasis after local excision of early squamous cell carcinoma of the oral cavity

A total of 54 patients with stage I and stage II squamous cell carcinoma of the oral cavity were reviewed as to treatment modality, adequacy of treatment, and site of failure. Surgery was employed as the sole initial treatment modality in 52 patients. Forty-three underwent primary tumor excision alone and 9 underwent elective neck dissection at the time of primary tumor excision. The patients who underwent elective neck dissection at the time of excision of the primary tumor had a 3 year survival rate of 88 percent, in comparison to a survival rate of 77 percent in those patients whose initial therapy was directed solely at the primary tumor. A low incidence of local recurrence (2 percent) and a high incidence of neck recurrence (42 percent) were documented in those patients treated by primary tumor excision alone. Patients who underwent salvage neck dissection for recurrent neck node metastases had a 3 year survival rate of 56 percent. This study has documented a high incidence of cervical node recurrence in patients with T1 and T2 squamous cell carcinomas of the oral cavity treated by primary tumor excision alone and a poor survival rate after salvage therapy. A small group of patients who underwent elective neck dissection had a demonstrably high survival rate. These observations lend support to the call for elective neck dissection in patients with stage I and II oral cavity carcinoma but are not conclusive. Therapeutic decisions regarding elective treatment of the neck will continue to be made according to the best judgment and prejudices of the individual surgeon until a prospective, randomized multi-institutional study addressing this specific issue is undertaken.     

Elective neck dissection in early‐stage oral squamous cell carcinoma—does it influence recurrence and survival?

BACKGROUND: This study investigates the influence on survival and regional control rates of neck dissection therapy at the time of surgery of the primary tumor in early stages of squamous cell carcinoma (SCC) of the oral cavity. METHODS: A series of 154 patients with pT1N0M0 and pT2N0M0 intraoral carcinomas was analyzed retrospectively. Neck dissection was associated with tumor ablation in 87 patients (56.5%), although 67 patients (43.5%) were treated with local resection exclusively. Survival and relapse rates were studied with the Kaplan-Meier curves and the log-rank test for univariate analysis and Cox proportional model for multivariate analysis (p < .05). RESULTS: Regional recurrences occurred in 25 cases (16.2%), 7 cases (8%) with primary neck dissection and 18 cases (26.8%) with local excision alone. Neck dissection therapy was a significant prognostic factor for recurrences and survival (p < .05). The 5-year regional control rate was of 92.5% for patients with elective lymph node ablation versus 71.2% for patients without primary neck dissection. Neck dissection was also significant for recurrences in stage I and for survival and recurrences in stage II. Neck dissection therapy also showed independent prognostic value in the Cox analysis. CONCLUSIONS: In patients with intraoral carcinomas, elective neck treatment should be considered even in cases with a small primary tumor and negative clinical examination because of the high incidence of occult nodal metastases and the tendency to regional recurrences.     

Clinically Significant, Isolated Metastatic Disease to the Thyroid Gland

n = 5), esophageal adenocarcinoma (n= 1), pulmonary squamous cell carcinoma (n= 1), gastric leiomyosarcoma (n= 1), lingual squamous cell carcinoma (n= 1), and parotid gland carcinoma (n= 1). Three patients underwent preoperative fine-needle aspiration (FNA), all of which were suggestive of metastatic disease. The mean time from resection of the primary tumor to thyroid metastases was 3.5 ± 6.0 years (range 0–19.5 years). Total thyroidectomy (n= 5) or lobectomy (n= 5) was performed without morbidity or mortality. After a median follow-up of 5.2 years six patients are alive and two are free of disease. Moreover, no patients have had recurrent disease in the neck. Thus carcinomas metastatic to the thyroid represent a rare cause of clinically significant thyroid disease, with RCCs comprising 50%. Most thyroid metastases (80%) present within 3 years of primary tumor resection, but with RCC they can occur as late as 19 years. The diagnosis of metastatic disease should be suspected in patients with even a remote history of cancer, especially RCC, and an FNA revealing clear cell or spindle cell carcinoma. Contrary to previous reports, long-term survival can be achieved after resection of the metastatic tumor. Furthermore, thyroidectomy may also palliate/prevent the potential morbidity of tumor recurrence in the neck.     

E-cadherin abnormalities resulting from CPG methylation promoter in metastatic and nonmetastatic oral cancer

BACKGROUND: This study aims to compare the alterations in the methylation profiles of E-cadherin in oral cancer, especially in tumors with lowest metatastic potential. METHODS: Nine oral verrucous carcinomas (VCs), 20 oral well-differentiated squamous cell carcinomas without lymph node involvement (SCC-pN0), and 17 with lymph node involvement (SCC-pN+) were analyzed using methylation-specific polymerase chain reaction and immunohistochemical expression of E-cadherin gene. RESULTS: The immunohistochemical expression of E-cadherin in VC was significantly higher (p = .016) when compared with SCC-pN0 and SCC-pN+ groups. The E-cadherin gene methylation was not correlated with its abnormal immunohistochemical expression in VC and SCC-pN0. All tumors of the SCC-pN+ group with unmethylated E-cadherin gene showed significant loss of E-cadherin immunoexpression (p = .044). CONCLUSIONS: The E-cadherin gene methylation presence in tumors with lowest invasive and metastatic potential, such as VC, suggests the early involvement of this epigenetic event in the multistep progression of the oral carcinogenesis.     

Risk factors for late cervical lymph node metastases in patients with stage I or II carcinoma of the tongue

BACKGROUND: Many histopathologic parameters in squamous cell carcinoma of the tongue have been identified as predictive factors for cervical lymph metastasis. However, predictive factors for occult cervical lymph node metastases and the criterion for elective therapy remain inconclusive. This study analyzed the clinicopathologic factors associated with late cervical lymph node metastases in patients with carcinoma of the tongue. METHODS: The clinicopathologic features of 50 consecutive patients seen between January 1985-December 1996 with previously untreated stage I or II squamous cell carcinoma of the tongue were reviewed. All patients were treated with partial glossectomy without elective neck dissection. Their mean age was 54.5 y (range, 23-90 y) and the male-female ratio was 1.2:1 (27 men and 23 women); 30 cases were stage I, and 20 cases were stage II. Clinicopathologic factors were analyzed to determine factors predicting late cervical lymph node metastasis. RESULTS: The overall cervical lymph node metastasis rate was 14.0% (7 of 50). Clinicopathologic factors significantly associated with the development of cervical lymph node metastasis were tumor size (> or =30 mm), tumor depth (> or =4 mm), differentiation, mode of invasion, microvascular invasion, and histologic grade of malignancy. In a multivariate logistic regression analysis, moderately differentiated squamous cell carcinoma of the tongue with tumor depth > or =4 mm had predictive value for late cervical lymph node metastasis and diminished overall survival (odds ratio, 10.0; p =.02; hazards ratio, 7.0; p =.039). CONCLUSIONS: The findings of this study demonstrate tumor depth > or =4 mm moderately differentiated squamous cell carcinoma of the tongue have a substantially higher rate of late cervical metastases. In the basis of these data, it is our recommendation that this be used in the decision to electively treat the neck.     

Preservation of the Internal Jugular Vein in the Radical Treatment of Node-Positive Neck—Is It Safe?

Background The aim of this study was to evaluate risk factors of neck recurrence in patients with pN+ necks submitted to a modified or a classic radical neck dissection and the safety of preserving the internal jugular vein in the treatment of a subgroup of these patients. Methods The medical records of 311 untreated patients with squamous cell carcinoma of the oral cavity (106 cases), oropharynx (95 cases), larynx (49 cases), and hypopharynx (61 cases) were reviewed. Their clinical stages (CS) were CS II in 1%, CS III in 19.9%, CS IVA in 76.2%, and CS IVB in 19.6% of the cases. All patients were pN+. Results Ipsilateral neck recurrence occurred in 18 cases (5.8%), 14 cases (4.5%) where the internal jugular vein was resected, and 4 cases (1.3%) where the internal jugular vein was preserved. Neck recurrence did not have significant correlation with tumor site (P = .852), T stage (P = .369), N stage (P = .963), adjuvant radiotherapy (P = .701), number of positive lymph nodes (P = .886), jugular vein preservation (P = .240), and extracapsular spread (P = .670). There was significant correlation between neck recurrence and the lymph node size (.040). Conclusions Modified radical neck dissection with internal jugular vein preservation can be performed in selected patients with lymph node metastases, with no significant increase in the risk of neck recurrence.     

Pulmonary Resection for Metastatic Head and Neck Cancer

BACKGROUND: Pulmonary metastasectomy has become the standard therapy for various metastatic malignancies to the lungs; however, little data have been available about lung metastasectomy for head and neck cancers. To confirm a role for resection of pulmonary metastases for such tumors, we reviewed our institutional experience. METHODS: Between 1991 and 2007, 20 patients with pulmonary metastases from head and neck cancers underwent complete pulmonary resection. All patients had obtained or had obtainable locoregional control of their primary head and neck cancers. Various perioperative variables were investigated retrospectively to analyze the prognostic factors for overall survival and disease-free survival after metastasectomy. RESULTS: Of the 20 patients, 10 (50%) had squamous cell carcinoma, 7 (35%) had adenoid cystic carcinoma, and 3 had miscellaneous carcinomas. The median disease-free interval from the time of treatment of the head and neck primary cancers to the development of pulmonary metastases was 27 months. Overall survival rate after metastasectomy was 59.4% at 5 years and 47.5% at 10 years, respectively. Disease-free survival rate was 25.0% at 5 years after pulmonary resection. A disease-free interval equal to or longer than 12 months was a significantly favorable prognostic factor for both overall survival and disease-free survival (p = 0.02 and 0.01, respectively). Patients with squamous cell carcinoma and male sex showed a worse overall survival (p = 0.04 and 0.03, respectively). CONCLUSION: The current practice of pulmonary metastasectomy for head and neck cancers in our institution was well justified. A disease-free interval equal to or longer than 12 months, nonsquamous cell carcinoma, and female sex might be relevant to a better prognosis.     

Prospective validation of the Martinez-Gimeno clinicopathologic scoring system (MGSS) for evaluating risk of cervical lymph node metastases of squamous cell carcinoma of the oral cavity

BACKGROUND: The prediction of neck metastasis from oral squamous cell carcinoma is an unresolved issue. The Martinez-Gimeno Scoring System (MGSS) is an index designed as a predictive aid that may be implemented after analysis of the tumor resection. METHODS: A double-blind cohort study was designed and carried out in a tertiary hospital. Seventy-nine consecutive patients diagnosed with squamous cell carcinoma of the oral cavity requiring local resection and neck dissections were included. After tumor resection, the MGSS was applied, and patients were then classified into one of four groups on the basis of the MGSS score: group I, 7 to 12 points; group II, 13 to 16 points; group III, 17 to 20 points; and group IV, 21 to 30 points. After this, pathologic analysis of the neck specimen was performed to detect metastasis. The results, histopathologic analysis of the neck specimens, and previously tabulated MGSS scores were then compared, and on the basis of their results an estimation of the predictive validity of MGSS of neck metastases was obtained. A correlational analysis was performed, comparing metastases to a set of predictive factors, including the MGSS score. A logistic binary regression model that used metastases as the dependent variable was adjusted in an attempt to estimate odd ratios for these factors. RESULTS: Twenty-six cases displayed metastases. The metastatic nodes measured from 0.5 to 7 cm and were smaller than 1.5 cm in 46% of the cases. The rates of metastases in the four groups were as follows: group 1, 0%; group II, 21%; group III, 50%; and group IV, 67%. MGSS had a sensitivity of 100% (95% confidence interval [CI], 98% to 100%) for predicting metastases from oral squamous cell carcinoma, a specificity of 55% (95% CI, 44% to 66%), an overall efficiency of 73% (95% CI, 63% to 83%), a positive predictive value of 59% (95% CI, 48% to 70%), and a negative predictive value of 100% (95% CI, 98% to 100%). The correlation between various predictive factors and the presence of metastases showed a value of r = .87 (p = .001) with the MGSS score. No correlation was found between the MGSS score and the size of the metastatic lymph node. In the logistic regression model, the MGSS score displayed an odds ratio of 3.5 (95% CI, 1.9-6.3; p = .00001) for the presence of metastases in patients with squamous cell carcinoma of the oral cavity. CONCLUSION: The MGSS is a useful index for the prediction of neck node metastases that is applied at the start of the analysis of the tumor resection in patients with squamous cell carcinoma of the oral cavity.     

Basaloid squamous cell carcinoma of the head and neck is a mixed variant that can be further resolved by HPV status

Basaloid squamous cell carcinoma (BSCC) of the head and neck is set apart as a distinct subtype of squamous cell carcinoma on the basis of its basaloid appearance and aggressive behavior. The purpose of this study was to determine whether BSCC could be further subdivided on the basis of human papillomavirus 16 (HPV16) status. HPV16 in situ hybridization was performed on 53 BSCCs of the head and neck. Of the 53 BSCCs, 21 (40%) arose in the oropharynx and 32 (60%) arose in nonoropharyngeal sites. HPV16 was detected in 34% of BSCCs overall, but the frequency varied by site. HPV16 was detected in 16 of 21 (76%) BSCCs of the oropharynx, but in only 2 of 32 (6%) BSCCs from nonoropharyngeal sites (P<0.0001, Fisher exact). The absence of HPV16 was significantly associated with decreased overall survival (Hazard ratio=17.1; 95% confidence interval=7.2-40.3, log-rank P=0.0001), even though patients with HPV16-positive carcinomas were more likely to present with lymph nodes metastases (P=0.01, Fisher exact). Morphologic similarities aside, BSCCs are composed of a mixed group of tumors that can be separated on the basis of HPV16 status. The distinction is important. HPV16-positivity in squamous cell carcinomas of the head and neck is now recognized as a powerful indicator of improved patient survival. HPV16 detection thus permits resolution of a less aggressive component within a high-grade subtype of head and neck carcinoma.