Predictive value of tumor thickness for cervical lymph-node involvement in squamous cell carcinoma of the oral cavity: a Meta-analysis of reported studies

Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario, Canada.
Cancer (Impact Factor: 4.89). 04/2009; 115(7):1489-97. DOI: 10.1002/cncr.24161
Source: PubMed


Tumor thickness (TT) appears to be a strong predictor for cervical lymph-node involvement in squamous cell carcinoma of the oral cavity (OSCC), but a precise clinically optimal TT cutoff point has not been established. To address this question, the authors conducted a meta-analysis.
All relevant articles were identified from MEDLINE and EMBASE as well as from cross-referenced publications cited in relevant articles. Lymph-node involvement was confirmed and identified as positive lymph-node declaration (P(LN)D) by either pathologic positivity on immediate neck dissection or by neck recurrence identified after follow-up > or = 2 years. Odds ratios (OR) were calculated to quantify the predictive value of TT. Negative predictive values (and the percentage of patients falsely predicted to not have P(LN)D [FN-P(LN)D]) were compared to determine the optimal TT cutoff point.
Sixteen studies were selected from 72 potential studies, yielding a pooled total of 1136 patients. Data were examined for the following TT cutoff points: 3 mm (4 studies, 387 patients), 4 mm (9 studies, 778 patients), 5 mm (6 studies, 367 patients), and 6 mm (4 studies, 488 patients). The OR (95% CI) was 7.3 (5.3-10.1) for the overall group. The proportion of FN-P(LN)D was 5.3% (95% CI, 2.0-11.2), 4.5% (2.6-7.2), 16.6% (11.5-22.8), and 13.0% (9.7-16.9) for TT<3, <4, <5, and <6 mm, respectively. There was a statistically significant difference between the 4-mm and 5-mm TT cutoff points (P = .007).
TT was a strong predictor for cervical lymph-node involvement. The optimal TT cutoff point was 4 mm.


Available from: Shao Hui Huang, Sep 23, 2014
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    • "Although computed tomography, magnetic resonance imaging and ultrasonography are useful tools to determine cervical node metastasis, it is still difficult to detect occult lymph node metastasis and to make a decision on neck dissection in early stage tongue cancer [8]. Tumor depth would be an important prognostic factor [9] [10]; however, the optimum cut-off value may vary [11]. SN involvement was also reported to be strongly correlated with the tumor location, tumor stage, depth of invasion and lymphovascular involvement [12]. "
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    ABSTRACT: Objective: To determine the validity of sentinel node navigation surgery (SNNS) in early stage tongue cancer, the occurrence rate of postoperative cervical metastasis (POCM) after lead plate technique (LPT) introduction and survival rates in patients who underwent SNNS were analyzed. Methods: SNNS was performed in 29 patients (stage I: 14, stage II: 15) from 2000 to 2007. Tc-labeled phytate was prepared as a radiotracer a day before SNNS. The sentinel node (SN) was then examined pathologically during surgery. For cases where metastasis in SN was positive, neck dissection was performed. Occurrence of POCM after LPT introduction was compared with that before LPT introduction. 'Wait and see' policy was performed in 52 patients (stage I: 27, stage II: 25) from 1987 to 1999 as a historical control. The observation period of SNNS cases and 'wait and see' policy cases ranged from 10 months to 165 months (median: 91 months) and from 7 months to 268 months (median: 87 months), respectively. Results: Six of the 29 SNNS cases (21%) were proven metastatic SNs. Before LPT introduction, POCM occurred in 2 of the 15 cases, while we had no occurrences after LPT introduction. The 5-year overall survival rate of the 29 patients who underwent SNNS and the 52 patients with 'wait and see' policy were 96% and 84%, respectively, and there was statistical significance in the two groups (p<0.05). Conclusions: As the survival rate of the patients with the SNNS tended to be better than that with the 'wait and see' policy in our cases, SNNS could avoid unnecessary neck dissection. SNNS provides useful information regarding decision-making for neck dissection in early stage tongue cancer.
    Auris Nasus Larynx 06/2014; 45(5):475-8. DOI:10.1016/j.anl.2014.05.003 · 1.14 Impact Factor
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    • "As described in the Introduction, the clinico-pathological predictors of outcome in patients with early stage OTSCC have been intensely studied. The critical depth of infiltration of the primary tumor in connection with nodal metastasis has been estimated to be around 4 mm [5, 9, 10]. In the present study, we examined 14 cases of OTSCC showing a range of infiltration depths from 1.9 to 10.6 mm. "
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    International Journal of Dentistry 10/2013; 2013(2):482765. DOI:10.1155/2013/482765
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    • "However, the presence of LVI or microscopic tumor foci in muscle increased the risk of recurrence and PORT should be considered. Tumor thickness, or alternative synonyms such as “depth of invasion” or “tumor depth”, has been consistently identified as a predictor for cervical lymph node metastasis (10). Recent studies have shown that pathological tumor thickness ≥ 4 mm combined with poorly differentiated pT1-2N0 OSCC tumors are associated with poor regional control and such patients may benefit from PORT (11). "
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