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Macroscopic and multiple metastases in sentinel lymph node biopsy are respectively associated with poor prognosis in early oral cancer

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Abstract

Background

A multicenter, randomized controlled phase III trial was conducted on sentinel lymph node biopsy (SLNB) and elective neck dissection for T1 (depth of invasion ≥ 4 mm)–T2N0M0 oral cavity squamous cell carcinoma. This study identified factors associated with poor prognosis in patients who underwent SLNB based on a subgroup analysis of this trial.

Methods

We analyzed 418 sentinel lymph nodes (SLNs) from 132 patients who underwent SLNB. The metastatic SLNs were classified into three categories based on size-isolated tumor cells: < 0.2 mm, micrometastasis: ≥ 0.2 mm and < 2 mm, and macrometastasis: ≥ 2 mm. Three groups were formed based on the number of metastatic SLNs: no metastasis, 1 metastatic node, and ≥ 2 metastatic nodes. The size and number of metastatic SLNs on survival were evaluated using Cox proportional hazard models.

Results

Patients with macrometastasis and ≥ 2 metastatic SLNs had worse overall survival (OS) and disease-free survival (DFS) after adjustment for potential confounders (HR for OS: macrometastasis, 4.85; 95% CI 1.34–17.60; ≥ 2 metastatic SLN, 3.63; 95% CI 1.02–12.89; HR for DFS: macrometastasis, 2.94; 95% CI 1.16–7.44; ≥ 2 metastatic SLN, 2.97; 95% CI 1.18–7.51).

Conclusions

In patients who underwent SLNB, a poorer prognosis was associated with macrometastasis or having ≥ 2 metastatic SLNs.

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Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

We thank the patients and their families for participating in this trial. We also thank the physicians, nurses, medical technicians, and research staff at the participating institutions. This study was supported by a Health and Labour Sciences Research Grant for Clinical Cancer Research (H21-Gannrinshou-Ippan-016 and H24-Gannrinshou-Ippan-006) from the Ministry of Health, Labour, and Welfare in Japan.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan

    Takahito Kondo

  2. Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan

    Kiyoaki Tsukahara

  3. Department of Otorhinolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya-shi, Aichi, 467-8601, Japan

    Daisuke Kawakita

  4. Department of Head and Neck Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Seiichi Yoshimoto

  5. Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan

    Kouki Miura

  6. Department of Head and Neck Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan

    Masashi Sugasawa

  7. Department of Otolaryngology-Head and Neck Surgery, Gunma University Graduate School of Medicine, 3-39-15 Showa-cho, Maebashi-shi, Gunma, 371-8511, Japan

    Kazuaki Chikamatsu

  8. Department of Head and Neck Surgery-Otolaryngology, Asahi University Hospital, 3-23 Hashimoto-cho, Gifu-shi, Gifu, 500-8523, Japan

    Takashi Matsuzuka & Yasuhisa Hasegawa

  9. Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, 1-1 Kanokoden, Chikusa-ku, Nagoya-shi, Aichi, 464-8681, Japan

    Isao Oze

  10. Department of Head and Neck Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada-cho, Kahoku-gun, Ishikawa, 920-0293, Japan

    Morimasa Kitamura

  11. Department of Pathological Diagnosis, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya-shi, Aichi, 460-0001, Japan

    Yoshiko Murakami

  12. Department of Head and Neck Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka-shi, Osaka, 541-8567, Japan

    Shinji Otozai

  13. Department of Head and Neck Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan

    Takeshi Shinozaki

  14. Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan

    Shinichi Ohba

  15. Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan

    Koji Araki

  16. Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 14, Nishi 5, Kita-ku, Sapporo-shi, Hokkaido, 060-8648, Japan

    Takatsugu Mizumachi

  17. Department of Otolaryngology, Head and Neck Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan

    Dai Sato

  18. Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, Ishikawa, 920-8641, Japan

    Naohiro Wakisaka

  19. Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa, 903-0215, Japan

    Hitoshi Hirakawa

Authors
  1. Takahito Kondo
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  2. Kiyoaki Tsukahara
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  3. Daisuke Kawakita
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  4. Seiichi Yoshimoto
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  5. Kouki Miura
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  6. Masashi Sugasawa
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  7. Kazuaki Chikamatsu
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  8. Takashi Matsuzuka
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  9. Isao Oze
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  10. Morimasa Kitamura
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  11. Yoshiko Murakami
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  12. Shinji Otozai
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  13. Takeshi Shinozaki
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  14. Shinichi Ohba
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  15. Koji Araki
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  16. Takatsugu Mizumachi
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  17. Dai Sato
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  18. Naohiro Wakisaka
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  19. Hitoshi Hirakawa
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  20. Yasuhisa Hasegawa
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Contributions

TK, KT, DK, and YH contributed to the study concept and design, quality control of data and algorithms, data analysis and interpretation, and manuscript preparation and editing. DK was responsible for statistical analysis. All authors contributed to data acquisition, manuscript review, and final approval of the manuscript and are accountable for all aspects of the work.

Corresponding author

Correspondence to Kiyoaki Tsukahara.

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The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Kondo, T., Tsukahara, K., Kawakita, D. et al. Macroscopic and multiple metastases in sentinel lymph node biopsy are respectively associated with poor prognosis in early oral cancer. Int J Clin Oncol 28, 512–520 (2023). https://doi.org/10.1007/s10147-023-02305-1

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  • DOI: https://doi.org/10.1007/s10147-023-02305-1

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