PROGNOSTIC SIGNIFICANCE OF TUMOR AND STROMAL FACTORS ON OCCURENCE OF DELAYED LYMPH NODE METASTASES (DLNM) AND SURVIVAL IN EARLY-STAGE ORAL SQUAMOUS CELL CARCINOMA (OSCC)

Presentation: B086
Topic: Oral Cavity
Type: Poster
Date:
Session:
Authors: Ivica Luksic, Assist Prof, PhD, MD1, Petar Suton, PhD, MD2
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Institution(s): 1University of Zagreb School of Medicine, Department of Maxillofacial Surgery, University Hospital Dubrava, 2Division of Radiation Oncology, Department of Radiotherapy and Medical Oncology, University Hospital for Tumors, University Hospital Centre Sisters of Mercy
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Introduction: The clinical course of early oral squamous cell carcinoma (OSCC) is largely unpredictable and the management of the clinically N0 neck in oral cancer patients remains controversial. To date, there is no imaging tehnique capable of detecting a micrometastatic lymph node and despite negative imagining results, some patients develop neck metastases in clinically N0 settings. The aim of the study was to identify clinicopathological parameters and immunohistochemical stromal factors predicting delayed lymph node metastases (DLNM) and survival in early OSCC in order to identify a subgroup of patients most likely to benefit from elective neck dissection. To our knowledge this is the first study in the English literature examining the role of both tumor and stromal factors infuencing the occurence of DLNM and survival in early-stage oral cancer.

Materials and methods: Immunohistochemistry was performed by the sensitive peroxidase-streptavidin method on formalin-fixed, paraffin embedded tissue. Expression of biomarkers was assayed by scoring fluorescence intensity or percentage of positive tumor cell throughout the representative tissue samples.

Results: Over the 5-year period 183 patients with OSCC were primarily surgically treated and eighty-five patients met the inclusion criteria. There were 68 males and 17 females (median age 61 years, range 34-82). Thirty-two cases were TNM stage I, and 53 cases were stage II. Of the patients, twenty-five (29.4%) developed DLNM within 3 to 42 months after treatment of the primary tumor, and sixty (70.6%) had no evidence of cervical lymph node metastasis. Multivariate logistic regression analysis identified poorly differentiated tumors, low laminin and high fibronectin expression as prognosticators of DLNM. Combination of these three factors was found to have 81.2% positive predictive value on DLNM occurence. Five-year DSS rate for the entire cohort was 85.2%. Cox's proportional hazards regression analysis demonstrated that moderately differentiated tumors and DLNM had predictive values regarding survival.

Conclusion: This data provides insight into important tumoral and stromal prognosticators which may be useful to define which high risk patients with oral cancer would most likely benefit from neck dissection in elective settings. Large prospective investigations with reproducibility and the clinical translatability of immunohistochemical methods are needed in order to provide new and effective therapeutic strategies in the future.

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