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.

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Available from: Shao Hui Huang, Sep 23, 2014
    • "The two elected features of this system have been individually described as predictors of prognosis for OSCC patients (Po WingYuen et al, 2002;O-Charoenrat et al, 2003;Wang et al, 2011;Ganly et al, 2013). Depth of tumor invasion or tumor thickness, as measured from the surface of the tumor to the deepest point of invasion, has been pointed out as a predictor for cervical lymph node metastasis (Po WingYuen et al, 2002;O-Charoenrat et al, 2003;Ganly et al, 2013) and reflects the aggressiveness of tumor growth by reaching out to the lymphovascular structures (Huang et al, 2009). Tumor budding is defined as single cancer cells or cell clusters composed of fewer than five cancer cells scattered in the stroma of the actively invasive front region (Ueno et al, 2002). "
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    ABSTRACT: This study evaluated the association of 4 histopathological grading systems (WHO grading system, malignancy grading of the deep invasive margins (MG), histological risk (HR) model and tumor budding and depth of invasion (BD) model) with clinicopathological parameters and outcome of 113 oral squamous cell carcinomas to identify their roles in prognosis. Demographic and clinical features were obtained from patients' records. Sections from all paraffin-embedded blocks were evaluated according to the 4 grading systems. Demographic and clinical associations were analyzed using chi-square test, and correlations between the grading systems were established with the Spearman's rank correlation test. Survival curves were performed with Kaplan-Meier method, and multivariate analysis based on Cox proportional hazard model was calculated. Significant associations with survival were observed for WHO grading system and BD model in the univariate analysis, but only the BD model was significantly associated with disease outcome as an independent prognostic marker. Age, tumor size and presence of regional metastasis were also independent markers of reduced survival. A significant association between the BD model and outcome of OSCC patients was observed, indicating this new histopathological grading system as a possible prognostic tool. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    No preview · Article · Mar 2015 · Oral Diseases
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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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    • "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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