to compare the rate of occult contralateral neck metastases (OCNM) in oral and oropharyngeal squamous cell carcinomas (SCC) reaching or crossing the midline and to identify risk factors for OCNM.
Materials and methods
we conducted a single-center retrospective study of oral and oropharyngeal SCC with contralateral cN0 neck. The cohort was divided into a midline-reaching (MR; approaching the midline from up to 10 mm) group and a midline-crossing (MC; exceeding the midline by up to 10 mm) group. Clinical N-status was assessed by a radiologist specializing in head and neck imaging. All patients underwent contralateral elective neck dissection (END).
A total of 98 patients were included in this study, 59 in the MR group and 39 in the MC group. OCNM were present in 17.3% of patients, 20.3% in the MR group and 12.8% in the MC group (p = 0.336). In multivariable analysis, MR/MC status as well as distance from the midline (in mm) were not identified as risk factors for OCNM. Conversely, oropharyngeal primary and clinical N-status above N1 were significantly associated with a higher risk of OCNM, with odds ratios (OR) of 3.98 (95% CI = 1.08–14.60; p = 0.037) and 3.41 (95% CI = 1.07–10.85; p = 0.038) respectively.
in patients with oral and oropharyngeal SCC extending close to or beyond the midline, tumor origin and clinical N-status should carry the most weight when dictating the indications for contralateral END, rather than the midline involvement in itself.
Abbreviations:END (elective neck dissection), SCC (Squamous Cell Carcinoma), ASCO (American Society of Clinical Oncology), OCNM (Occult Contralateral Nodal Metastasis), ND (Neck Dissection), MR (Midline-Reaching), MC (Midline-Crossing), DOI (Depth Of Invasion), RT (Radiotherapy), OR (Odds-Ratio), PET (18-fluorodeoxyglucose Positron Emission Tomography), CT (Computed Tomography), MRI (Magnetic Resonance Imaging), SLNB (Sentinel Lymph Node Biopsy)
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- Topographical distribution of sentinel nodes and metastases from T1-T2 oral squamous cell carcinomas.Eur J Cancer. 2019; 107 (Oxford, England: 1990): 86-92https://doi.org/10.1016/j.ejca.2018.10.021
- Management of the neck in squamous cell carcinoma of the oral cavity and oropharynx: ASCO clinical practice guideline.J Clin Oncol: Offic J Am Soc Clinic Oncol. 2019; 37: 1753-1774https://doi.org/10.1200/JCO.18.01921
- Bilateral versus ipsilateral neck dissection in oral and oropharyngeal cancer with contralateral cN0 neck.Eur Arch Oto-Rhino-Laryngol. 2020; 277: 3161-3168https://doi.org/10.1007/s00405-020-06043-2
- Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up.Ann Oncol. 2020; 31: 1462-1475https://doi.org/10.1016/j.annonc.2020.07.011
- Contralateral neck failure in oral tongue cancer: outcomes from two centers using predefined treatment criteria.Head Neck. 2021; 43: 2024-2031https://doi.org/10.1002/hed.26671
- Patients with unilateral squamous cell carcinoma of the tongue and ipsilateral lymph node metastasis do not profit from bilateral neck dissection.Oral Maxillofac Surg. 2018; 22: 185-192https://doi.org/10.1007/s10006-018-0690-1
- Survival outcomes after treatment of cancer of the oral cavity (1985-2015).Oral Oncol. 2019; 90: 115-121https://doi.org/10.1016/j.oraloncology.2019.02.001
- Prognostic factors in oropharyngeal cancer--analysis of 627 cases receiving definitive radiotherapy.Acta Oncol. 2009; 48: 1026-1033https://doi.org/10.1080/02841860902845839
- Elective versus therapeutic neck dissection in node-negative oral cancer.N Engl J Med. 2015; 373: 521-529https://doi.org/10.1056/NEJMoa1506007
- Elective neck dissection and survival in patients with squamous cell carcinoma of the oral cavity and oropharynx.Laryngoscope. 2004; 114: 2228-2234https://doi.org/10.1097/01.mlg.0000149464.73080.20
- Prognostic factors influencing contralateral neck lymph node metastases in oral and oropharyngeal carcinoma.J Oral Maxillofac Surg: Offic J Am Assoc Oral Maxillofac Surg. 2010; 68: 268-275https://doi.org/10.1016/j.joms.2009.09.071
- Clinical predictors for contralateral neck lymph node metastasis from unilateral squamous cell carcinoma in the oral cavity.Oral Oncol. 2004; 40: 898-903https://doi.org/10.1016/j.oraloncology.2004.04.004
- A novel classification scheme for advanced laryngeal cancer midline involvement: implications for the contralateral neck.J Cancer Res Clin Oncol. 2017; 143: 1605-1612https://doi.org/10.1007/s00432-017-2419-1
- The effect of midline crossing of lateral supraglottic cancer on contralateral cervical lymph node metastasis.Acta Otolaryngol. 2015; 135: 484-488https://doi.org/10.3109/00016489.2014.986759
- Incidence of contralateral-bilateral nodes in the human papillomavirus era.Laryngoscope. 2017; 127: 1328-1333https://doi.org/10.1002/lary.26439
- Occult lymph node metastasis in the contralateral neck of oropharyngeal squamous cell carcinoma: a meta-analysis and literature review.Eur Arch Oto-Rhino-Laryngol. 2022; 279: 2157-2166https://doi.org/10.1007/s00405-021-07230-5
- A review of clinical and histological parameters associated with contralateral neck metastases in oral squamous cell carcinoma.Int J Oral Sci. 2011; 3: 180-191https://doi.org/10.4248/IJOS11068
- Ipsilateral neck nodal status as predictor of contralateral nodal metastasis in carcinoma of tongue crossing the midline.Head Neck. 2013; 35: 649-652https://doi.org/10.1002/hed.23019
- Occult contralateral nodal metastases in supraglottic laryngeal cancer crossing the midline.Eur Arch Oto-Rhino-Laryngol: Off J Europ Federat Oto-Rhino-Laryngol Soci (EUFOS): Aff German Soci Oto-Rhino-Laryngol - Head and Neck Surg. 2009; 266: 117-120https://doi.org/10.1007/s00405-008-0721-x
- Paratracheal lymph node dissection for carcinoma of the larynx, hypopharynx, and cervical esophagus.Otolaryngol Head Neck Surg. 1993; 108: 11-17https://doi.org/10.1177/019459989310800102
- Paratracheal lymph node dissection during total (pharyngo-)laryngectomy: a systematic review and meta-analysis.Oral Oncol. 2022; 132106017https://doi.org/10.1016/j.oraloncology.2022.106017
- Preoperative evaluation of depth of invasion in oral tongue squamous cell carcinoma: a systematic review and meta-analysis.Oral Oncol. 2023; 136106273https://doi.org/10.1016/j.oraloncology.2022.106273
- Correlation between radiologic depth of invasion and pathologic depth of invasion in oral cavity squamous cell carcinoma: a systematic review and meta-analysis.Oral Oncol. 2023; 136106249https://doi.org/10.1016/j.oraloncology.2022.106249
- What is the role of sentinel lymph node biopsy in the management of oral cancer in 2020?.Eur Arch Oto-Rhino-Laryngol. 2021; 278: 3181-3191https://doi.org/10.1007/s00405-020-06538-y
- An extended use of the sentinel node in head and neck squamous cell carcinoma: results of a prospective study of 100 patients.Acta Otorhinolaryngol Ital. 2004; 24: 145-149
- Selection of lymph node target volumes for definitive head and neck radiation therapy: a 2019 Update.Radiother Oncol. 2019; 134: 1-9https://doi.org/10.1016/j.radonc.2019.01.018
Published online: April 04, 2023
Accepted: March 23, 2023
Received in revised form: February 24, 2023
Received: November 2, 2022
Publication stageIn Press Journal Pre-Proof
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