Study The Lingual Lymph Node Metastasis And The Significance Of En Bloc Resection Of Primary, Floor Of Mouth And Neck In Squamous Cell Carcinoma Of Tongue

Objective:To study the presence rate, metastasis rate of lingual lymph nodes and regional lymph nodes metastases in the patiens with squamous cell carcinoma of tongue and to investigate their relative factors.To explore the significance of treating tongue cancer by en bloc resection of primary, floor of mouth and neck.Methods:We collected 52 patients with tongue cancer treated by en block resection of primary, floor of mouth and neck from March 2007 to December 2007 and then measured the tumor thickness, dissected out lingual lymph nodes,cervical lymph nodes and inferior parotid gland lymph nodes. Each node was made on a single section stained with routine haematoxylin and eosin (HE). All negative lymph nodes diagnosed by HE were re-examined by anti-cytokeratin (CK) immunohistochemical (IHC) staining combined with semiserial sectioning at 400 um intervals. All patients were regular followed-up.Results:The rate of regional lymph nodes metastasis was 50%(26/52), the metastasis rate in the group of stage T1,T2,T3 and T4 were 15.4%,50%, 100%, 100% respectively.Metastasis rate of ipsilateral level IV, V were 5.8%(3/52),5.8%(3/52) respectively.There were relationgship between T stage or tumor thickness in the primary and regional lymph nodes metastasis (P<0.05) . The presence rate of lateral lingual lymph nodes was 30.8%( 16/52), the rate of metastasis to lingual lymph nodes was 19.2%(10/52), the metastasis rate in the group of stage T1,T2,T3 and T4 were 3/4, 4/9, 2/2, 1/1 respectively.Follow up 6-14 months,the early failure rate was 17.4%,the recurence rate in primary site was 7.7%,in primary site and ipsilateral neck was 1.9%,the metastasis rate in contralateral neck was 5.8%, in distant site (lung) was 1.9%.Conclusion: In the study, the presence rate of lingual lymph nodes was 30.8%, the rate of metastasis to lingual lymph nodes was 19.2%. Maybe lingual lymph node was the first echelon draining the primary site when the patient had lingual lymph node. It was the positive relationship between T staging or perpendicular infiltrate depth and the rate of regional lymph nodes transferred. En bloc resection of primary, floor of mouth and neck was suggested to treat the patients with maximum tumor thickness≥8 mm.