Macroscopic and multiple metastases in sentinel lymph node biopsy are respectively associated with poor prognosis in early oral cancer

Takahito Kondo; Kiyoaki Tsukahara; Daisuke Kawakita; Seiichi Yoshimoto; Kouki Miura; Masashi Sugasawa; Kazuaki Chikamatsu; Takashi Matsuzuka; Isao Oze; Morimasa Kitamura; Yoshiko Murakami; Shinji Otozai; Takeshi Shinozaki; Shinichi Ohba; Koji Araki; Takatsugu Mizumachi; Dai Sato; Naohiro Wakisaka; Hitoshi Hirakawa; Yasuhisa Hasegawa

doi:10.1007/s10147-023-02305-1

Macroscopic and multiple metastases in sentinel lymph node biopsy are respectively associated with poor prognosis in early oral cancer

Int J Clin Oncol. 2023 Apr;28(4):512-520. doi: 10.1007/s10147-023-02305-1. Epub 2023 Feb 16.

Authors

Takahito Kondo¹, Kiyoaki Tsukahara², Daisuke Kawakita³, Seiichi Yoshimoto⁴, Kouki Miura⁵, Masashi Sugasawa⁶, Kazuaki Chikamatsu⁷, Takashi Matsuzuka⁸, Isao Oze⁹, Morimasa Kitamura¹⁰, Yoshiko Murakami¹¹, Shinji Otozai¹², Takeshi Shinozaki¹³, Shinichi Ohba¹⁴, Koji Araki¹⁵, Takatsugu Mizumachi¹⁶, Dai Sato¹⁷, Naohiro Wakisaka¹⁸, Hitoshi Hirakawa¹⁹, Yasuhisa Hasegawa⁸

Affiliations

¹ Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan.
² Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan. tsuka@tokyo-med.ac.jp.
³ Department of Otorhinolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya-shi, Aichi, 467-8601, Japan.
⁴ Department of Head and Neck Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
⁵ Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan.
⁶ Department of Head and Neck Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan.
⁷ Department of Otolaryngology-Head and Neck Surgery, Gunma University Graduate School of Medicine, 3-39-15 Showa-cho, Maebashi-shi, Gunma, 371-8511, Japan.
⁸ Department of Head and Neck Surgery-Otolaryngology, Asahi University Hospital, 3-23 Hashimoto-cho, Gifu-shi, Gifu, 500-8523, Japan.
⁹ Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, 1-1 Kanokoden, Chikusa-ku, Nagoya-shi, Aichi, 464-8681, Japan.
¹⁰ Department of Head and Neck Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada-cho, Kahoku-gun, Ishikawa, 920-0293, Japan.
¹¹ Department of Pathological Diagnosis, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya-shi, Aichi, 460-0001, Japan.
¹² Department of Head and Neck Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka-shi, Osaka, 541-8567, Japan.
¹³ Department of Head and Neck Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan.
¹⁴ Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
¹⁵ Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan.
¹⁶ Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 14, Nishi 5, Kita-ku, Sapporo-shi, Hokkaido, 060-8648, Japan.
¹⁷ Department of Otolaryngology, Head and Neck Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan.
¹⁸ Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, Ishikawa, 920-8641, Japan.
¹⁹ Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa, 903-0215, Japan.

PMID: 36795281
DOI: 10.1007/s10147-023-02305-1

Abstract

Background: A multicenter, randomized controlled phase III trial was conducted on sentinel lymph node biopsy (SLNB) and elective neck dissection for T1 (depth of invasion ≥ 4 mm)-T2N0M0 oral cavity squamous cell carcinoma. This study identified factors associated with poor prognosis in patients who underwent SLNB based on a subgroup analysis of this trial.

Methods: We analyzed 418 sentinel lymph nodes (SLNs) from 132 patients who underwent SLNB. The metastatic SLNs were classified into three categories based on size-isolated tumor cells: < 0.2 mm, micrometastasis: ≥ 0.2 mm and < 2 mm, and macrometastasis: ≥ 2 mm. Three groups were formed based on the number of metastatic SLNs: no metastasis, 1 metastatic node, and ≥ 2 metastatic nodes. The size and number of metastatic SLNs on survival were evaluated using Cox proportional hazard models.

Results: Patients with macrometastasis and ≥ 2 metastatic SLNs had worse overall survival (OS) and disease-free survival (DFS) after adjustment for potential confounders (HR for OS: macrometastasis, 4.85; 95% CI 1.34-17.60; ≥ 2 metastatic SLN, 3.63; 95% CI 1.02-12.89; HR for DFS: macrometastasis, 2.94; 95% CI 1.16-7.44; ≥ 2 metastatic SLN, 2.97; 95% CI 1.18-7.51).

Conclusions: In patients who underwent SLNB, a poorer prognosis was associated with macrometastasis or having ≥ 2 metastatic SLNs.

Keywords: Neck dissection; Oral cancer; Sentinel lymph node.

Publication types

Randomized Controlled Trial
Multicenter Study
Clinical Trial, Phase III

MeSH terms

Breast Neoplasms* / pathology
Disease-Free Survival
Female
Humans
Lymph Nodes / pathology
Lymph Nodes / surgery
Lymphatic Metastasis / pathology
Mouth Neoplasms* / pathology
Mouth Neoplasms* / surgery
Neck Dissection
Sentinel Lymph Node Biopsy
Sentinel Lymph Node* / pathology
Sentinel Lymph Node* / surgery

Abstract

Publication types

MeSH terms

Grants and funding