Study On Factors Related To Cervical Lymph Nodes Metastasis Of Oral Squamous Cell Carcinoma

Objective1. To explore the regularity of cervical lymph nodes metastasis in Oral squamous cell carcinoma (OSCC).2. To explore the relationship between Cervical lymph nodes metastasis (CLNM) and age, gender, location, differentiation degree, depth of invasion, pathological T stage of OSCC.3. To explore the relationship between Extracapsular spread(ECS) and differentiation degree, depth of invasion, pathological T stage, pathological N stage, number of positive lymph nodes of OSCC.Materials and Methods Clinicopathologic data of755cases with OSCC were retrospectively reviewed from Jan.2008-Dec.2012in the Department of Oral and Maxillofacial Surgery, the Second Xiangya Hospital of Central South University. The cases were grouped according to age, gender, location, pathological TNM stage, depth of invasion, differentiation degree, distribution of positive lymph nodes, to explore the regularity of CLNM and the relationship between clinicopathologic factors and CLNM/ECS by χ2test、Fisher test and Logistic regression analysis.Results1. The incidence of CLNM was35.9%(271/755), and the incidence of skip metastasis was1.2%(7/567) 2. The positive cervical lymph nodes were mainly concentrated at level Ⅰ Ⅱ Ⅲ, while rarely involved at level Ⅳ Ⅴ. The incidence of CLNM for each level was:level129.2%(155/530), level Ⅱ36.8%(195/530), level Ⅲ21.5%(114/530), level IV7.7%(41/530), level Ⅴ4.7%(25/530).3. There were different distributions of positive lymph nodes for different tumor primary site. The incidence of skip metastasis of tongue carcinoma was1.9%, the incidence of CLNM for base of tongue carcinoma(51.6%) was significantly higher than body of tongue carcinoma (36.9%), P<0.05; The incidence of CLNM for anterior and posterior buccal carcinoma was not statistically significant, P>0.05; the incidence of CLNM for anterior mouth floor carcinoma(63.6%) was significantly higher than posterior mouth floor carcinoma (20.8%), P<0.05.4. Through the univariate analysis of the study, age、differentiation degree、depth of invasion、pathological T stage were significantly associated with CLNM, P<0.05. While gender location were not significantly associated with CLNM, P>0.05; Through the multivariate analysis of the study, only differentiation degree、depth of invasion、 pathological T stage were significantly associated with CLNM, P<0.05. Depth of invasion was the first impact factor of CLNM of OSCC.(OR=2.244) 5. The incidence of ECS was31.7%(86/271).The location of the primary site was not significantly associated with ECS, P>0.05.6. Depth of invasion pathological T stage、pathological N stage、 number of positive lymph nodes were significantly associated with ECS, P<0.05. Differentiation degree was not significantly associated with ECS, P>0.05. We recommend the number of positive>2as an indication for ECS of OSCC.Conclusions1.The positive cervical lymph nodes were mainly concentrated at level Ⅰ Ⅱ Ⅲ, while rarely involved at level Ⅳ Ⅴ. There were different distribution of positive lymph nodes for different tumor primary site.2.It was positive relationship between CLNM and pathological T stage、depth of invasion. It was negative relationship between CLNM and differentiation degree. CLNM was not significantly associated with location. Depth of invasion was the first impact factor of CLNM of OSCC.3. It was positive relationship between ECS and pathological depth of invasion、pathological T stage、pathological N stage、number of positive lymph nodes. ECS was not significantly associated with differentiation degree、location. We recommend the number of positive>2as an indication for ECS of OSCC.