[Relationship between extracapsular spread of cervical metastatic lymph node and cervical recurrence in oral cancer patients].

OBJECTIVE: To investigate the relationship between extracapsular spread (ECS) of cervical metastatic lymph node and the recurrence in patients with oral squamous cell carcinoma (OSCC). METHODS: The medical records of 74 OSCC patients with histologically confirmed cervical lymph node metastasis were reviewed. They were divided into 2 groups, ECS positive (ECS+) and ECS negative (ECS-). The treatment results were followed up. Statistical analysis, with chi-square test, and multiple logistic regression was conducted. RESULTS: The overall recurrence rates for pN+/ECS- and pN+/ECS+ patients were 47.6% and 75.0%, respectively, and the cervical recurrence rates for pN+/ECS- and pN+/ECS+ patients were 9.5% and 46.9%, respectively (P < 0.001). Multivariate analysis showed that ECS was one of the independent prognosis factors for cervical recurrence. CONCLUSIONS: Extracapsular spread significantly increased both overall and cervical recurrence rates, and ESC may be a prognosis factor for OSCC patients.

[The impacts of various types of neck dissection on postoperative shoulder function for patients with oral squamous cell carcinoma].

OBJECTIVE: To compare the impact of various types of neck dissection on postoperative shoulder function. METHODS: The shoulder functions of 66 patients with oral squamous cell carcinoma (OSCC) and cN0 necks who underwent various types of neck dissection were evaluated by Constant's shoulder function test and neck dissection impairment index at least 12 months after surgery. RESULTS: The patients with accessory spinal nerve reserved had better shoulder function than those with accessory spinal nerve resected. In the group with accessory spinal nerve reserved, the patients receiving selective neck dissection (SND) showed better shoulder function than those with modified radical neck dissection (MRND). The shoulder dysfunction and pain arising from SND were minor in patients with selective neck dissection. CONCLUSIONS: The shoulder function after SND was superior to those after RND and MRND.

[Analysis on occult micrometastasis in levels III - IV of cN0 neck in patients with oral tongue squamous cell carcinoma].

OBJECTIVE: To investigate the frequency of micrometastasis in levels lII - IV of clinical negative neck (cN0) in patients with squamous cell carcinoma (SCC) of oral tongue, and to discuss the management of cervical lymph node for cN0 tongue SCC. METHODS: A total of 471 cervical lymph nodes derived from 25 patients with cN0 tongue SCC, including 263 lymph nodes in level III and 208 lymph nodes in level IV, were included in this study. All lymph nodes were re-examined by anti-cytokeratin (CK) immunohistochemical staining combined with semi-serial section per 500 microm. RESULTS: Among the 25 cases, seven patients were confirmed harboring metastasis in 11 lymph nodes of level III, and no positive lymph node in level IV was detected by routine hematoxylin-eosin (HE) staining. 11 positive lymph nodes in level IIl, which confirmed by HE staining, were also detected by immunohistochemical staining with CK combined with semiserial section. Among the 460 cervical lymph nodes in which HE staining did not show metastasis, only one lymph node in level III harboring a 2.0 mm x 1.5 mm micrometastasis was detected by immunohistochemical staining with CK, and no positive lymph node in level IV was detected by immunohistochemical staining with CK. CONCLUSION: The frequency of occult metastasis in level IV was very low, so it seemed unnecessary to dissect level IV for all patients with cN0 tongue SCC.