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 newlineComplex (GBC) or Indian Oral Cancer, is a distinct cancer of oral cavity in the newlineIndian subcontinent. Cervical lymph node metastasis (CLNM) is a validated newlineprognostic factor in mandibular GBC-SCC like other subsites of oral SCC. CLNM in newlineoral SCC is known to occur in a foreseeable manner, involving mainly level I, level II newlineand to lesser extent level III nodes unlike tongue or floor-mouth SCC wherein, the newlineCLNM tends to be extensive. The available guidelines for neck dissection (ND) in newlinenode-positive necks for oral SCC are based on western studies, which comprise more newlineof tongue and floor-mouth SCC and lack patients with mandibular GBC-SCC. Also, newlinethe literature about accurate nodal staging in Indian patients with mandibular GBC- newlineSCC is scanty with regards to adequacy of lymph-nodes to be harvested following newlineND. Furthermore, the extent of CLNM in advanced oral SCC is influenced by clinico- newlinepathological factors that have to be identified for risk stratification with regards to newlinedecision making on the extent of ND in patients with mandibular GBC-SCC. This will newlinehelp surgeons to practice oncologically safe ND for patients with high risk of newlineextensive CLNM and contrarily to perform limited-extent ND in low risk patients, newlinethus avoiding morbidities related to comprehensive ND. newline newlineAim and Objectives: To study the metastatic involvement of cervical lymph-nodes newline(CLNs) at various levels in the neck from primary mandibular GBC-SCC and newlinequantify the number of lymph-nodes harvested from comprehensive ND. To study the newlinexiv contribution of clinico-pathological factors like T-size, histological differentiation newline(HD), infiltration of bone by the tumor, lympho-vascular tumor emboli (LVE) and newlineperineural Invasion (PNI) in CLNM. newline