Title : Behavior of advanced (T3 & T4) squamous cell carcinoma of the oral cavity
Abstract:
Squamous cell carcinoma (SCC) is the most common malignant neoplasm of the oral cavity. SCC is a major health problem for the world. Based on GLOBOCAN estimates, about 377,713 new cancer patients and 177,757 deaths occurred in 2020 worldwide. The load of oral squamous cell carcinoma is remarkably greater in India when compared to the western countries with 60 to 80% of our patients are documented in locally advanced stages (American Joint Committee on Cancer, Stage III-IV). The purpose of this study was to evaluate the neck node status, patterns of neck metastasis, distribution of patients according to T (T3 & T4) stage and management of squamous cell carcinoma of the oral cavity. Methodology: 82 histopathologically proven cases of oral squamous cell carcinoma were included in our study. T3 and T4 (advanced) lesions of oral squamous cell carcinoma cases were considered. Recurrent cases and prior treatment of oral cancer by chemotherapy and radiotherapy were excluded. All the patients involved in the study underwent tumor resection with neck dissection. Results: A total of 82 patients were staged as per TNM criteria (AJCC 8th edition). The percentage of T4 and T3 lesions were 68.30% and 31.70% respectively. The most common oral squamous cell carcinoma site was the buccal mucosa (n=42) followed by the tongue (n=19), lower alveolus (n=16), palate (n=2) and 1 patient each in floor of mouth, lip and RMT region. 53.66% patients were pathologically node-positive (pN+) and 46.34% patients were pathologically node- negative (pN0). In pathologically node-positive patients N3 category was the highest followed by N2 category and N1 category. Nearly 25% patients were pathologically node-positive with extranodal extension (pN+/ENE+) and in this category 10 out of 26 cases were present in buccal mucosa. The lymph node positivity was highest in T4 followed by T3. More than 90% metastases occurred at levels I to III lymph nodes. 62 and 20 patients were treated by surgery with postoperative radiotherapy and surgery with postoperative CTRT respectively. Conclusion: This study showed that nearly 54% (forty four out of eighty two) of the patients were pathologically node-positive (pN+) and nearly one-fourth (twenty out of eighty two) of the patients were pathologically node-positive with extranodal extension (pN+/ENE+). More than 90% metastases occurred at levels I to III lymph nodes. Histopathology reports demonstrated the most of the patients had well-differentiated squamous cell carcinoma. The dominant site was the buccal mucosa and it is the most common oral squamous cell carcinoma in the Indian subcontinent.
