Monalisa Banerjee¹, Ankit Gupta¹, Shehnaz Kantharia² and Rajesh Kantharia¹*

¹Department of Head and Neck Oncosurgery, Kailash Cancer Hospital and Research Centre, Muni Seva Ashram, Goraj, India
²Department of Otorhinolaryngology/Head and Neck Oncosurgery, Kailash Cancer Hospital and Research Centre, Muni Seva Ashram, Goraj, India

*Corresponding Author: Rajesh Kantharia, Department of Head and Neck Oncosurgery, Kailash Cancer Hospital and Research Centre, Muni Seva Ashram, Goraj, India.

Received: July 10, 2023; Published: July 24, 2023

Abstract

Aim: Oral cavity cancers have high propensity for lymphatic dissemination which strongly influences the prognosis and reduces survival by 50%. This study aims to estimate the survival outcomes of patients operated for Oral Cavity Squamous Cell Carcinoma with N3b nodal disease.

Methodology: Retrospective analysis of prospectively collected data of final histopathology report of patients operated for advanced Oral Cavity Squamous Cell Carcinoma with N3b nodal disease from January 2018 to January 2020 was done. Out of the 113 patients, 55 patients were included in this study. Patients with incomplete treatment and follow ups were excluded. The demographic details, tumor sub-sites, tumor stage, nodal stage, adjuvant treatment received, type of neck dissection and nodal yield were analyzed. The primary end point of the study was to assess the overall survival and Disease free survival.

Results: The total number of neck dissections performed, were 55, of which modified neck dissection (MND) were 30 and supraomohyoid neck dissection (SOHD) were 25. Overall survival data of patients were found to be ≤6 months in 7 patients (12.7%), 7months - 1year in 15 patients (27.27%), 1.1-2 years in 16 patients (29.09%), 2.1-3 years in 13 patients (23.63%) and >3 years in 4 patients (7.27%).

Conclusion: Node positivity is the single most important detrimental factor of survival in Oral cavity squamous cell carcinoma and the worst prognosis group is patients with N3b nodal disease and advanced T stage.

 Keywords: Extra Nodal Extension; N3b Node; Survival Outcome; Neck Dissection; Prognosis; Squamous Cell Carcinoma

References

1. Huang Shao Hui., et al. "Assessment criteria and clinical implications of extranodal extension in head and neck cancer”. American Society of Clinical Oncology Educational Book41 (2021): 265-278.
2. Byrd, David R., et al. AJCC cancer staging manual. Eds. Mahul B. Amin, Stephen B. Edge, and Frederick L. Greene. New York: springer, 1024 (2017).
3. Brierley James D., et al. TNM classification of malignant tumours. John Wiley and Sons (2017).
4. Cooper Jay S., et al. "Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck”. New England Journal of Medicine19 (2004): 1937-1944.
5. Bernier Jacques., et al. "Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer”. New England Journal of Medicine19 (2004): 1945-1952.
6. Bernier Jacques., et al. "Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (# 22931) and RTOG (# 9501)”. Head and Neck: Journal for the Sciences and Specialties of the Head and Neck10 (2005): 843-850.
7. Forastiere Arlene A., et al. "Long-term results of RTOG 91-11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer”. Journal of clinical Oncology7 (2013): 845-852.
8. Mamic M., et al. "Prognostic significance of extranodal extension in oral cavity squamous cell carcinoma with occult neck metastases”. International Journal of Oral and Maxillofacial Surgery3 (2021): 309-315.
9. Zanoni, Daniella Karassawa et al. “Changes in the 8^th Edition of the American Joint Committee on Cancer (AJCC) Staging of Head and Neck Cancer: Rationale and Implications”. Current Oncology Reports6 (2016): 52.
10. Lydiatt WM., et al. “Head and Neck cancers-major changes in the American Joint Committee on cancer eighth edition cancer staging manual”. CA Cancer Journal of Clinics2 (2017): 122-137. 
11. Bhattacharya Priyanka and Rajarshi Mukherjee. "Lymph node extracapsular extension as a marker of aggressive phenotype: Classification, prognosis and associated molecular biomarkers”. European Journal of Surgical Oncology4 (2021): 721-731.
12. Woolgar J A., et al. "Cervical lymph node metastasis in oral cancer: the importance of even microscopic extracapsular spread”. Oral Oncology2 (2003): 130-137.
13. Kalnins Inars K., et al. "Correlation between prognosis and degree of lymph node involvement in carcinoma of the oral cavity”. The American Journal of Surgery4 (1977): 450-454.
14. Geum Dong-Ho., et al. "The impact factors on 5-year survival rate in patients operated with oral cancer”. Journal of the Korean Association of Oral and Maxillofacial Surgeons5 (2013): 207.
15. Gil Ziv., et al. "Lymph node density is a significant predictor of outcome in patients with oral cancer”. Cancer: Interdisciplinary International Journal of the American Cancer Society24 (2009): 5700-5710.
16. Kim SY., et al. “Prognostic value of lymph node density in node-positive patients with oral squamous cell carcinoma”. Annals of Surgery Oncology 18 (2011): 2310-2317.
17. Hua Yong-hong., et al. “Effect of number and ratio of positive lymph nodes in hypopharyngeal cancer”. Head and Neck1 (2015): 111-116.
18. Sayed Suhail I., et al. "Can metastatic lymph node ratio (LNR) predict survival in oral cavity cancer patients”. Journal of Surgical Oncology4 (2013): 256-263.

Citation

Citation: Rajesh Kantharia., et al. “Survival Outcomes in Patients with N3b Nodal Disease in Oral Cavity Squamous Cell Carcinoma: A Single Institutional Study".Acta Scientific Otolaryngology 5.8 (2023): 24-29.

Copyright

Copyright: © 2023 Rajesh Kantharia., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.