Abstract

GONZALEZ-GARCIA, R. et al. Contralateral neck metastasis in squamous cell carcinoma of the oral cavity: An analytical retrospective clinical study of 315 patients primarily treated with surgery. Rev Esp Cirug Oral y Maxilofac [online]. 2008, vol.30, n.3, pp.157-171. ISSN 2173-9161.

Objectives. There are numerous studies in the literature on the prognostic factors involved in the appearance of ipsilateral neck metastasis in squamous cell carcinoma of the oral cavity. However, there are no extensive clinical studies on the association of clinicopathological factors and the appearance of contralateral neck metastasis after the surgical resection of the primary tumor. The object of this study is to analyze the factors implied in the appearance of contralateral neck metastasis in patients with squamous cell carcinoma of the oral cavity treated primarily with surgery. Patients and methods. A series of 315 consecutive patients with squamous cell carcinoma of the oral cavity, who had not been treated previously, were analyzed. A complementary study of a subgroup of 203 patients with squamous cell carcinoma of the lateral border of the mobile tongue was carried out, as this was a very prevalent group in the series analyzed. The patients all received surgical treatment with or without adjuvant radiotherapy treatment. Various clinical and histopathological variables were analyzed, such as the clinical characteristics of the tumor, tumor stage, degree of histological differentiation, type of neck dissection, disease-specific survival, surgical margins of the resected specimen, extracapsular lymph node extension, perineural dissemination and bone involvement. Results. The mean follow-up of patients who survived was 70.9 ± 49.6 months. Eighty-three patients died as a result of the disease during the follow-up period. Forty-six of these belonged to the subgroup of patients with squamous cell carcinoma of the tongue. A total of 147 patients remained alive with no evidence of disease recurrence at the end of the follow-up period, 116 of whom corresponded to the subgroup of patients with squamous cell carcinoma of the tongue. The mean rate of disease-free survival was147± 6 months. Twenty-nine (9.1%) of patients developed ipsilateral neck recurrence, while 18 (5.69%) showed contralateral neck recurrence. For patients with squamous cell carcinoma of the tongue, and considering the percentages in relation to the 203 patients with this entity, these figures were 20 (9.8%) and 9 (4.4%) respectively. The mean time it took for neck metastasis to appear following surgery was 12.52 months (range 3-49), somewhat less for the subgroup of patients with squamous cell carcinoma of the tongue (11.4 months, range 3-27). Eighteen of the 29 patients with ipsilateral neck recurrence finally died of the disease. Seven of the 18 patients with contralateral metastasis also died of the disease. In the subgroup of patients with squamous cell carcinoma of the tongue these figures were: 14 of the 20 patients with ipsilateral neck metastasis and eight of the nine patients with contralateral neck metastasis. Various clinico pathological factors showed an association that was statistically significant (p<0.05) with regard to the appearance of contralateral neck metastasis such as: time until diagnosis, tumor stage, histopathological differentiation, surgical margins with regard to primary tumor resection, tumor thickness, type of neck dissection and perineural infiltration. Only the ipsilateral clinical N stage showed a statistically significant association (p<0.05) in the subgroup of patients with squamous cell carcinoma of the mobile tongue. Conclusion. A delay of 12 months or more in the diagnosis of squamous cell carcinoma of the oral cavity is associated with an increased risk of contralateral neck metastasis. Other predictive factors for the appearance of contralateral neck metastasis are stage IV tumor by TNM classification, the poor histopathological differentiation of the primary tumor, the presence of surgical margins of less than 1 cm in the resection specimen of the primary tumor, carrying out ipsilateral functional neck dissection in an isolated fashion and perineural involvement. The presence of ipsilateral neck nodes that are clinically positive at diagnosis is associated with an increased incidence of contralateral neck recurrence of squamous cell carcinoma of the oral cavity and mobile tongue. The appearance in most cases of contralateral neck recurrence in the two years after surgery, implied that carrying out a close following of these patients is necessary.

Keywords : Squamous cell carcinoma; Oral cavity; Tongue; Neck metastasis.

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