Study On The Extraxapsular Spread In Cervical Lymph Nodes Of Oral Squamous Cell Carcinoma

Objective1. To explore the relationship between Cervical nodal extracapsular spread (ECS) and T stage of the Oral squamous cell carcinoma(OSCC), tumor thickness, differentiation degree, lymph node size.2. To explore the difference in direction of ECS in each lymph node levels.3. To explore the influence of ECS to the prognosis of patients.MethodsWe collected38patients with OSCC treated by combined radical operation in the Department of Stomatology, the Second Xiangya Hospital of Central South University from Dec2010to Aug2011. measured the size, tumor thickness of the lesions with straightedge after the surgury; recorded the the number and sizes of the lymph node in each lymph node level, and The lymph node was divided into two sides, shallow side and deep side, then sent the specimens to the Department of Pathology. Pathological findings after operation was differentiation degree standard. The relationship between ECS and T stage of the OSCC, tumor thickness, differentiation degree, lymph node size and the difference in direction of ECS in each lymph node level were to the statistical analysis. Results1.38Patients in the study. T19cases, T222cases, T35cases, T42cases. The incidence of ECS was25%(4/16),50.8%(33/65),45%(9/20),40%(6/15) respectively. it was not statistically significant between them(p=0.306>0.05).2.There were11cases whose tumor thickness<8mm, the incidence of ECS was22.7%; and27cases whose tumor thickness≥8mm, the incidence of ECS was50%in38cases of OSCC, there was statistically significant between them(p=0.031<0.05).3.38patients of OSCC in the study. There were27cases with well differenliated, the incidence of ECS was38.5%;11cases with moderately or poorly differenliated, the incidence of ECS was57.9%. The correlation of tumor differentiation degree and the incidence of ECS was statistically significant(p=0.048<0.05).4. There were116metastatic lymph nodes in the study, including52(44.8%) extracapsular spread nodes. According to the lymph node size,the lymph nodes were divided into4groups:≤5mm,5-10mm,10-20mm,>20mm, the incidence of ECS was17.1%,43.75%,59.3%,63.6%respectively. There was statistically significant between them (p<0.001).5. There were52extracapsular spread nodes, the frequency of the shallow side was44, frequency of the deep side was34, the difference in the direction of ECS was statistically significant (p=0.042<0.05).19extracapsular spread nodes in level I, the requency of the shallow side was17, frequency of the deep side was9, the difference in the direction of ECS was statistically significant (p=0.015<0.05). But the difference in other levels was not statistically significant.6. There were19patients who had extracapsular spread nodes, six months and nine months survival rate was68.75%,62.5%respectively; there were19patients who had not extracapsular spread nodes, six months and nine months survival rate was100%,87.5%respectively.7. There were4extracapsular spread nodes that was boundary positive in the study.3patients with the4lymph nodes, they died after3to4months, cervical recurrence in1patient, distant metastasis in2patients.Conclusion1. It was positive relationship between incidence of ECS and the tumor thickness of OSCC, lymph node size; It was negative relationship between incidence of ECS and the differentiation degree of OSCC.2. The difference in the direction of ECS was statistically significant. ECS in the shallow side was more than that in the deep side of lymph nodes in level I. The difference in other levels was not statistically significant.3.The survival rate of the patient who had extracapsular spread nodes was reduced, the survival rate was further reduced by the boundary positive of ECS.