Even small-stage oral SCC metastases impact prognosis

By Sarah Guy

The presence of even small tumor-cell deposits in the lymph nodes of patients with early oral and oropharyngeal squamous cell carcinoma (SCC) reflects a potential for the primary tumor to metastasize, report researchers in Head and Neck.

Their study findings show that both macro- and micrometastatic disease presence negatively impact disease-specific survival (DSS) and overall survival (OS) rates significantly.

The results also indicate sentinel lymph node biopsy (SLNB) is a feasible way to accurately stage patients with early oropharyngeal SCC, while allowing for minimally invasive treatment of the neck.

SLNB can result in "focused surgery," which ultimately reduces morbidity for the patient, say Sandro Stoeckli from Kantonsspital St Gallen, Switzerland, and colleagues.

The team evaluated SLNB outcomes in a cohort of 111 consecutive patients with stage T1/T2 cN0 oropharyngeal SCC treated at their institution between 2003 and 2010.

After excision of 99% of patients' sentinel lymph nodes (SLNs), the investigators conducted an extensive histopathologic workup and found occult metastasis in the form of isolated tumor cells (ITCs) in 24% of patients, micrometastases in 19 patients, and macrometastases in 13 patients.

In the subsequent neck dissection performed in all of these patients, 14% had additional lymph node metastasis.

Overall, patients' estimated 3-year OS, DSS, and disease-free survival (DFS) was 88%, 91%, and 89%, respectively, and these values were significantly lower in SLN-positive than SLN-negative patients, calculate Stoeckli and co-workers.

By contrast, the respective 3-year estimated DSS, OS, and DFS for patients with ITCs were 89%, 74%, and 75%, for patients with micrometastases were 66%, 71%, and 71%, and for patients with macrometastases were 67%, 67%, and 65%, respectively.

Micro- and macrometastases, but not ITCs - likely due to low numbers - also had significantly higher adjusted hazard ratios for OS, DSS, and DFS, report Stoeckli et al.

"The relevance of the prognostic meaning of small tumor deposits is the answer to the crucial and not yet resolved question whether their detection in one or multiple SLNs should be an indication for adjuvant treatment," concludes the team.

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