The Impact and Prognostic Significance of Extra-Nodal Extension in Clinically N0 Oral Cancer: A Prospective Clinical Study.

Oral cavity squamous cell carcinoma (OCSCC) demonstrates a high propensity to metastasize to regional lymph nodes. Despite technological and scientific advances, identification of pathological adverse features preoperatively remains elusive. This study intended to identify the true occurrence of extra-nodal extension (ENE) in clinically and radiologically N0 OCSCC patients and to investigate its impact and prognostic significance. A prospective, single-centre, non-randomized study was conducted at a tertiary cancer centre in South India to include all untreated operable patients of OCSCC without clinical, radiological, or cytological evidence of nodal metastasis (cN0). All the patients underwent tumor resection surgery with neck dissection and received adjuvant therapy when indicated. Patients were followed up and neck dissection specimens were histopathologically analyzed. The primary outcome was to assess the presence of ENE in cN0 OCSCC patients and its extent. The secondary outcomes were 2-year disease-free survival (DFS) and tumor characteristics. A total of 237 patients with operable OCSCC were evaluated. Out of these, 80 patients who were clinically and radiologically N0 were included in the study and they underwent tumor resection surgery and neck dissection. The final histopathological evaluation revealed that 21.25% of patients (n = 17) had metastatic neck disease and 7.5% of patients (n = 6) had ENE, and all were reported as microscopic ENE. Within the node-positive group, the 2-year DFS for patients with and without ENE were 50% and 90.9%, respectively (p = 0.0362). The results suggest that ENE remains a strong predictor of adverse outcomes, recurrence, and survival in oral cancer patients.

Maxillary Leiomyosarcoma with Lymph Node Metastasis: Report of an Unusual Case.

Leiomyosarcoma is an unusual, malignant, mesenchymal neoplasm that is extremely rare in head and neck region. It clinically presents as a well-defined, painless mass which could easily be misdiagnosed as a benign lesion, posing a diagnostic challenge to the clinician. Head and neck leiomyosarcomas are very aggressive and have a poor prognosis. Hence, early diagnosis plays a vital role in its appropriate management.

Upper oral cavity tumors: Is the risk of nodal metastasis different?

The state of the clinically evident cervical lymph nodes at the time of diagnosis is one of the most important factors impacting long-term survival. While squamous cell carcinomas (SCC) of the hard palate and maxillary alveolus are uncommon in comparison to other primary sites, there is a scarcity of published data on the effective management of the neck nodes for malignancies of these specific subsites. In such circumstances, an intraoperative frozen section or Sentinel node biopsy would aid in the optimal therapy of the neck.

Swallowing: A delayed milestone post-surgery in tongue cancers.

Functional rehabilitation remains an important factor in the post-operative period following tongue cancer surgeries. Patients undergoing surgery for tongue cancers require intense rehabilitation in order to restore their swallowing function, and improve their nutritional status and quality of life. Various swallowing scales like the Functional Oral Intake Scale (FOIS), Performance status scale in head and neck cancer (PSSHNC) and 100 ml water swallow test are used to assess functionality in these patients. These aid in timely assessment and early intervention for better rehabilitation, in turn improving quality of life. Nasogastric tube (NG) or percutaneous endoscopic gastrostomy (PEG) aids in providing adequate nutrition in the immediate post-operative period and during adjuvant therapy to overcome radiation-induced dysphagia.

Assessment of Pretreatment Neutrophil/Lymphocyte Ratio and Platelet/Lymphocyte Ratio in Prognosis of Oral Squamous Cell Carcinoma.

PURPOSE: Recent data have provided evidence of systemic inflammatory markers playing an important role in determining the disease-free survival (DFS) and overall survival (OS) of patients with oral squamous cell carcinoma (OSCC). The aim of the present study was to determine the prognosis of OSCC using the preoperative neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR). PATIENTS AND METHODS: We enrolled 130 patients with OSCC who received treatment in the present retrospective study. Both PLR and NLR correlated with the demographic data, tumor characteristics, and prognosis. The optimal cutoff for PLR and NLR was determined by receiver operating characteristic curve analysis and was 142 and 3.1 for PLR and NLR, respectively. The prognostic significance of both markers was determined by univariate and multivariate analysis. Survival curves were plotted using the Kaplan-Meier method. RESULTS: The clinicopathologic variables correlated with cumulative survival on univariate analysis. Advanced clinical lymph node stage (P = .001), pathologic lymph node stage (P = .001), pathologic tumor stage (P = .049), pathologic TNM stage (P = .006), receipt of multimodality treatment (P = .013), and high PLRs (P = .001) and NLRs (P = .002) showed a statistically significant association with shorter DFS. A multivariate Cox proportional hazard regression model demonstrated that a high PLR (hazard ratio [HR], 2.998; 95% confidence interval [CI], 1.128 to 7.968; P = .028) and patient age (HR, 1.100; 95% CI, 0.750 to 1.613; P = .025) were independent factors for determining DFS and OS. CONCLUSIONS: We observed that high PLRs and NLRs were significant in determining the prognosis. The PLR was superior to the NLR in determining DFS and OS and can be used as an independent prognostic indicator in patients with OSCC.