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Impact of extranodal spread of neck metastases on survival in head and neck carcinomas
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023-DClinical management of malignant neoplasm
modality for early oral SCCs based on their malignant potential for loco-regional recurrence. Materials and Methods: 102 patients With stage I and II SCC of the oral cavity treated by local excision alone were examined clinicopathologically, and factors related to locoregional recurrence were also investigated. Results and Conclusions: Among the 102 patients, 14 patients (13.7%) had local recurrence and 18 (17.6%) had cervical lymph node metastasis. Factors associated with local recurrence were margin status and absence or presence of pericancerous epithelial dysplasia. In addition, we found a significant correlation between neck metastasis and clinical growth pattern, d e p t h of invasion, and mode of invasion. Interestingly, clinical growth pattern shows a good correlation with these histological parameters, including absence or presence of pericancerous dysplasia, margin status, depth of invasion, and mode of invasion. Superficial tumors, which frequently accompany pericancerous epithelial dysplasia, should be excised at least 5 mm or more away from the lesion, including dysplastic epithelium. Exophytic tumors of 20 mm or less in size can be treated by local excision (excisional biopsy) alone. Because endophytic tumors have a high aggresivity and a high propensity to metastasize to cervical lymph nodes, patients with endophytic tumors over 5.0 mm in depth of invasion should receive neck dissection simultaneously. Endophytic tumors of 15 mm or less in size can be treated by excisional biopsy. In addition, as incisional biopsy increases the risk of cancer cells spreading, chemotherapy prior to biopsy is effective in controlling micrometastases.
8. The Prediction of Lymph Node Metastasis in Carcinoma of the Tongue by Multivariate Analysis
Nagata, T., Ozeki, S., Ohishi, M. l, Arita, S.~ 1First Department of OMS, Faculty of Dentistry, Kyushu Univ., Fukuoka, Japan, 2Department of Mathematics, Kansai Medical Univ., Osaka, Japan The present study describes the results of an analysis performed in an attempt to predict cervical lymph node metastasis in carcinoma of the tongue. In a previous study, 137 patients with squamous cell carcinoma of the tongue who were treated at our institution from 1971 to 1990 were investigated. Statistically, the quantification theory Type II of Hayashi (1954) was employed for discriminatory analysis. According to it, the correlations between the clinical (age, tumour size, N-category) and histopathological (degree of keratinization, mitosis, structure, mode of invasion) findings and metastasis were assessed on the basis of the partial correlation coefficients. Ninety-four patients out of 137 patients (75.9%) could be differentiated accurately. Furthermore, 63 out of the 86 patients (73.3%) of the NO category at the first consultation were discriminated accurately. When the method of this discriminatory analysis was applied to new cases which were treated from 1991 to 1992, 21 cases (65.6%) were predicted accurately. The accuracy of predicting cases among N0 was 72.0%.
From the results above, the accuracy of this discriminant analysis was not satisfactorily high. Some histopathological items such as keratinization and structure are subjective factors and the numerical values of each category varied exceedingly. Therefore, the diagnostic logic using Fuzzy theory is being examined for the accurate prediction of cervical lymph node metastasis.
9. Impact of Extranodal Spread of Neck Metastases on Survival in Head and Neck Carcinomas
Shingaki, S., Yoshizawa, M., Takada, 34., Nomura, T., Suzuki, L, Nakajima, T. First Department of Oral and Maxillofacial Surgery, School of Dentistry, Niigata University, Niigata, Japan Background: Extranodal spread (ENS) of lymph node metastases from carcinomas of the head and neck is a frequent histologic finding, but its significance for prognosis remains controversial. A retrospective study was undertaken to examine the influence of ENS on the pattern of recurrence and survival. Methods: A total of 64 patients with squamous cell carcinoma of the head and neck' who had metastases to neck lymph nodes were included. The independent prognostic values of clinical and histological variables for survival were assessed. Results: Thirty-one (48%) of the 64 patients had evidence of ENS. Variables such as tumor location, T and N stage, and the number of positive nodes did not have any influence on identification of ENS. Tumor differentiation and level of positive nodes, however, were associated with a high risk of ENS. Univariate analysis showed that the presence or absence of ENS (P<0.01) and level of positive nodes (levels III or IV vs. less than III; P<0.05) were prognostically significant factors. Disease-specific survival was significantly lower in patients with ENS (41% vs. 75%) and in patients with levels III or IV positive nodes (44% vs. 63%). ENS was also associated with increased distant metastases. Postoperative radiotherapy was found to have no significant effect on survival rates (63% vs. 45%). The survival rates of all of the patients at 5 and 10 years were 57% and 57%, respectively. Conclusion: The results confirm the prognostic significance of ENS in head and neck carcinomas. The association of D M with ENS indicates the importance of using ENS in considering intensive adjuvant chemotherapy.
023-DClinical management of malignant neoplasm
modality for early oral SCCs based on their malignant potential for loco-regional recurrence. Materials and Methods: 102 patients With stage I and II SCC of the oral cavity treated by local excision alone were examined clinicopathologically, and factors related to locoregional recurrence were also investigated. Results and Conclusions: Among the 102 patients, 14 patients (13.7%) had local recurrence and 18 (17.6%) had cervical lymph node metastasis. Factors associated with local recurrence were margin status and absence or presence of pericancerous epithelial dysplasia. In addition, we found a significant correlation between neck metastasis and clinical growth pattern, d e p t h of invasion, and mode of invasion. Interestingly, clinical growth pattern shows a good correlation with these histological parameters, including absence or presence of pericancerous dysplasia, margin status, depth of invasion, and mode of invasion. Superficial tumors, which frequently accompany pericancerous epithelial dysplasia, should be excised at least 5 mm or more away from the lesion, including dysplastic epithelium. Exophytic tumors of 20 mm or less in size can be treated by local excision (excisional biopsy) alone. Because endophytic tumors have a high aggresivity and a high propensity to metastasize to cervical lymph nodes, patients with endophytic tumors over 5.0 mm in depth of invasion should receive neck dissection simultaneously. Endophytic tumors of 15 mm or less in size can be treated by excisional biopsy. In addition, as incisional biopsy increases the risk of cancer cells spreading, chemotherapy prior to biopsy is effective in controlling micrometastases.
8. The Prediction of Lymph Node Metastasis in Carcinoma of the Tongue by Multivariate Analysis
Nagata, T., Ozeki, S., Ohishi, M. l, Arita, S.~ 1First Department of OMS, Faculty of Dentistry, Kyushu Univ., Fukuoka, Japan, 2Department of Mathematics, Kansai Medical Univ., Osaka, Japan The present study describes the results of an analysis performed in an attempt to predict cervical lymph node metastasis in carcinoma of the tongue. In a previous study, 137 patients with squamous cell carcinoma of the tongue who were treated at our institution from 1971 to 1990 were investigated. Statistically, the quantification theory Type II of Hayashi (1954) was employed for discriminatory analysis. According to it, the correlations between the clinical (age, tumour size, N-category) and histopathological (degree of keratinization, mitosis, structure, mode of invasion) findings and metastasis were assessed on the basis of the partial correlation coefficients. Ninety-four patients out of 137 patients (75.9%) could be differentiated accurately. Furthermore, 63 out of the 86 patients (73.3%) of the NO category at the first consultation were discriminated accurately. When the method of this discriminatory analysis was applied to new cases which were treated from 1991 to 1992, 21 cases (65.6%) were predicted accurately. The accuracy of predicting cases among N0 was 72.0%.
From the results above, the accuracy of this discriminant analysis was not satisfactorily high. Some histopathological items such as keratinization and structure are subjective factors and the numerical values of each category varied exceedingly. Therefore, the diagnostic logic using Fuzzy theory is being examined for the accurate prediction of cervical lymph node metastasis.
9. Impact of Extranodal Spread of Neck Metastases on Survival in Head and Neck Carcinomas
Shingaki, S., Yoshizawa, M., Takada, 34., Nomura, T., Suzuki, L, Nakajima, T. First Department of Oral and Maxillofacial Surgery, School of Dentistry, Niigata University, Niigata, Japan Background: Extranodal spread (ENS) of lymph node metastases from carcinomas of the head and neck is a frequent histologic finding, but its significance for prognosis remains controversial. A retrospective study was undertaken to examine the influence of ENS on the pattern of recurrence and survival. Methods: A total of 64 patients with squamous cell carcinoma of the head and neck' who had metastases to neck lymph nodes were included. The independent prognostic values of clinical and histological variables for survival were assessed. Results: Thirty-one (48%) of the 64 patients had evidence of ENS. Variables such as tumor location, T and N stage, and the number of positive nodes did not have any influence on identification of ENS. Tumor differentiation and level of positive nodes, however, were associated with a high risk of ENS. Univariate analysis showed that the presence or absence of ENS (P<0.01) and level of positive nodes (levels III or IV vs. less than III; P<0.05) were prognostically significant factors. Disease-specific survival was significantly lower in patients with ENS (41% vs. 75%) and in patients with levels III or IV positive nodes (44% vs. 63%). ENS was also associated with increased distant metastases. Postoperative radiotherapy was found to have no significant effect on survival rates (63% vs. 45%). The survival rates of all of the patients at 5 and 10 years were 57% and 57%, respectively. Conclusion: The results confirm the prognostic significance of ENS in head and neck carcinomas. The association of D M with ENS indicates the importance of using ENS in considering intensive adjuvant chemotherapy.