“Pattern of cervical lymph node metastasis And its association with clinico-pathological Variables in primary mandibular gingivobuccal Sulcus squamous cell carcinoma”

Abstract

Background: Squamous cell carcinoma (SCC) of mandibular Gingivo-Buccal Complex (GBC) or “Indian Oral Cancer,” is a distinct cancer of oral cavity in the Indian subcontinent. Cervical lymph node metastasis (CLNM) is a validated prognostic factor in mandibular GBC-SCC like other subsites of oral SCC. CLNM in oral SCC is known to occur in a foreseeable manner, involving mainly level I, level II and to lesser extent level III nodes unlike tongue or floor-mouth SCC wherein, the CLNM tends to be extensive. The available guidelines for neck dissection (ND) in node-positive necks for oral SCC are based on western studies, which comprise more of tongue and floor-mouth SCC and lack patients with mandibular GBC-SCC. Also, the literature about accurate nodal staging in Indian patients with mandibular GBC- SCC is scanty with regards to adequacy of lymph-nodes to be harvested following ND. Furthermore, the extent of CLNM in advanced oral SCC is influenced by clinico- pathological factors that have to be identified for risk stratification with regards to decision making on the extent of ND in patients with mandibular GBC-SCC. This will help surgeons to practice oncologically safe ND for patients with high risk of extensive CLNM and contrarily to perform limited-extent ND in low risk patients, thus avoiding morbidities related to comprehensive ND.

Aim and Objectives: To study the metastatic involvement of cervical lymph-nodes (CLNs) at various levels in the neck from primary mandibular GBC-SCC and quantify the number of lymph-nodes harvested from comprehensive ND. To study the contribution of clinico-pathological factors like T-size, histological differentiation (HD), infiltration of bone by the tumor, lympho-vascular tumor emboli (LVE) and perineural Invasion (PNI) in CLNM.