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carcinoma that has originated laterally in the oral cavity. variable, together with tumor extension across the
midline, was the most important risk factor in the
Tumor size logistic regression analysis performed in this report.
The literature reports a strong correlation between the Other studies have also shown a significant correlation
size of the primary and the risk of CLNM. [24-28] A significant between the presence of ipsilateral and CLNM. [6,8] In
[23]
correlation between the T-stage and the occurrence of the study of Olzowy et al. patients with two or more
[5]
CLNM was observed by Kurita et al. In this study, the ipsilateral neck metastases showed significantly more
incidence of CLNM for the T4 tumor (31.4%) was relatively bilateral metastases compared with patients with fewer
high compared to that for the T1 (0%) as well as the than two positive ipsilateral lymph nodes.
T2 (12.2%) and T3 tumor (11.8%). In addition, CLNM in
[20]
patients with the T2 and T3 tumor occurred only in cases In contrast to these previous studies, González-García et al.
of the mobile tongue, but not in other sites. Excluding did not found an association between the presence of clinical
cases of the tongue SCC, CLNM was unlikely in patients and pathological positive node status on the ipsilateral side
with T1 to T3 oral carcinoma that had arisen in the of the neck and a higher incidence of contralateral cervical
unilateral side. In a retrospective analysis of 66 patients metastasis in SCC of the lateral side of the tongue.
[8]
with cancer of the oral cavity at N0-2 stage, Koo et al.
showed that the rate of contralateral occult metastasis Extracapsular spread
was 8% for T2, 25% for T3, and 18% for T4, whereas no Transcapsular infiltration of lymph node metastases is
metastasis was observed in the T1 cases. another important prognostic factor that, although it can
be found in smaller lymph nodes, is generally associated
Tumor thickness with lymph nodes with a diameter of more than 2 cm.
[13]
Tumor thickness has been recognized as an histological In a retrospective study performed by Feng et al., they
prognostic factor of local recurrence, cervical nodal demonstrated that extracapsular spread (ECS) status was
metastasis, and survival. Bier-Laning et al. found an correlated with 5-year CLNM. In a series of 913 patients,
[9]
approximately 5% increased risk of CLNM for every 1-mm Liao et al. also showed that the 5-year CLNM rate was
[31]
increase in tumor thickness. They did not found cases significantly higher in patients with ECS (39%) than in
of CLNM when the primary tumor had a thickness less those without (12%). Furthermore, the 5-year overall
than 3.75 mm. So, they recomended that consideration survival was 48% in patients without ECS, whereas it
should be given to observation of the contralateral neck dropped to 16% in those with ECS.
for tumors less than 3.75 mm, neck dissection to the
[8]
contralateral neck for tumors more than 3.75 mm thick, However, other authors such as Koo et al. did not find
and treatment of the contralateral neck with surgery and/ a statistical assocciation between ECS and the ocurrence
or radiation therapy if the tumor is more than 9.5 mm of CLNM.
thick. This is compatible with the findings of others, in
which the risk of ipsilateral nodal metastasis is increased Clinical tumor node metastasis stage
in tumors thicker than 4-5 mm. [29,30] Other authors, as It has been reported that patients with advanced tumors are
[12]
González-García et al. failed to show tumoral thickness at a higher risk for CLNM in OSCC. [5,6,12] In the multivariate
[6]
greater than 2 mm as predictive for CLNM, which could analysis performed by Kowalski et al., it became clear that
be attributable to the insufficient sample size where 7.1% the risk of CLNM for patients with clinical stage (CS) I and II
of the patients with tumor thickness greater than 2 mm tumors not involving the floor of the mouth was low, even
developed CLNM in comparison with 0% of the patients though it crossed midline (< 1 cm). On the other side, CS
with tumor thickness less than 2 mm. IV tumors that were less than 1 cm away from midline had
a high risk of metastasis, independent of tumor original
Infiltration of the cervical lymph nodes site. Frequency of such metastases was 33% for stage
In relation to cervical affectation, ipsilateral lymph neck T4, 15% for CS III and 32% for CS IV. Risk of contralateral
node metastasis has been referred to as a significant metastases was over 20% in stage T1-3 N2a-3 and T4 N0-3
[12]
predictor in assessing the risk to the contralateral neck. M0 tumors. González-García et al. found in their series
According to the statistical results of Kurita et al., no that 6.7% of patients with staging IV in the tumor node
[5]
CLNM occurred in patients without ipsilateral lymph metastasis (TNM) classification developed CLNM, whereas
node metastasis. In addition, the incidence of CLNM only 2.6% of patients with TNM staging I showed CLNM.
was higher in patients with multinode involvement (50%)
than in those with single node involvement (26.1%). The Surgical margins
study reported by Capote-Moreno et al. supported In relation to surgical resection, the absence of wide
[7]
these results, in which 21.6% of the cases with positive enough margins in the excised primary tumor has been
homolateral nodes showed positive CLNM whereas reported to be a predictor for CLNM. Particularly, the
contralateral disease developed in only 6.4% of the presence of 1 cm or more of non-affected tissue around
cases with negative homolateral nodes. This prognostic the tumor was considered adequate, in contrast to
184 Plast Aesthet Res || Volume 3 || June 24, 2016