Abstract
Oral cancers are the most common malignancy affecting Indian population with buccal mucosa being the frequent subsite. This study is to evaluate the histopathological factors influencing locoregional recurrence (LRR) and disease-free survival (DFS) in buccal mucosal squamous cell carcinoma (BSCC). One hundred and twenty patients treated surgically for BSCC with a curative intend between January 2014 and December 2015 were retrospectively analyzed. Histopathological factors like tumor stage, grade of differentiation, tumor front, skin involvement, bone involvement, depth of invasion, perineural invasion, lymphovascular emboli, primary resection margin in frozen section, nodal stage, extracapsular extension, and lymph node ratio were analyzed and compared for LRR and DFS. With a median follow-up of 41 months, LRR occurred in 34 patients (28.3%) and a 2-year DFS was 75.8%. Multivariate analysis identified that the factors that independently influenced the LRR were pathological nodal stage (p < 0.0001) and primary resection margin in frozen section (p < 0.0001). A single neck node involvement increases risk by 6.8 times for LRR compared to no nodal involvement (95% CI 2.897–15.888, p < 0.0001). Frozen section studies on primary tumor excision margin showed that close margin had 2.3 times chance of LRR (95% CI 1.020–5.035, p < .045) and involved margin showed 20.9 times risk of LRR compared to clear margin(95% CI 6.529–67.021, p < 0.0001). Primary resection margin on frozen section and pathological nodal status are the most important factors influencing LRR and DFS. This study highlights importance of aggressive treatment and close follow-up even with a single node involvement and when frozen section margin clearance is less than 5 mm.
Similar content being viewed by others
References
Dandekar M, Tuljapurkar V, Dhar H, Panwar A, DCruz AK (2017) Head and neck cancers in India. J Surg Oncol 115(5):555–563
Kaur J, Jacobs R (2016) Salivary and serum leptin levels in patients with squamous cell carcinoma of the buccal mucosa. Clin Oral Investig 20(1):39–42
Pandey A, Desai A, Ostwal V, Patil V, Kulkarni A, Kulkarni R, Patil N, Chaukar D, Prabhash K, Banavali SD (2016) Outcome of operable oral cavity cancer and impact of maintenance metronomic chemotherapy: a retrospective study from rural India. South Asian J Cancer 5(2):52–55
Pop LA, Eijukenboom WM, De Boer MF, De Jong PC, Knegt P, Levendag PC, Meeuwis CA, Reichgelt BA, Van Putten WL (1989) Evaluation of treatment results of squamous cell carcinoma of the buccal mucosa. Int J Radiat Oncol Biol Phys 16(2):483–487
Safi AF, Grandoch A, Nickenig HJ, Zöller JE, Kreppel M (2017) Importance of lymph node ratio for locoregional recurrence of squamous cell carcinoma of the buccal mucosa. Head Neck 39(12):2488–2493
Singhania V, Jayade BV, Anehosur V, Gopalkrishnan K, Kumar N (2015) Carcinoma of buccal mucosa: A site specific clinical audit. Indian J Cancer 52(4):605–610
Diaz EM, Holsinger FC, Zuniga ER, Roberts DB, Sorensen DM (2003) Squamous cell carcinoma of the buccal mucosa: one institution’s experience with 119 previously untreated patients. Head Neck 25(4):267–273
Paymaster JC (1956) Cancer of the buccal mucosa. A clinical study of 650 cases in Indian patients. Cancer 9(3):431–435
Ganpathi Iyer S, Pradhan SA, Pai PS, Patil S (2004) Surgical treatment outcomes of localized squamous carcinoma of buccal mucosa. Head Neck 26(10):897–902
Padma R, Thilagavathi R, Sundaresan S (2016) Survival outcomes of buccal mucosa carcinoma patients with multimodal therapy: an institutional study. Int J Nutr Pharmacol Neurol Dis 6(2):76
Iype EM, Pandey M, Mathew A, Thomas G, Sebastian P, Nair MK (2001) Oral cancer among patients under the age of 35 years. J Postgrad Med 47(3):171
Niu LX, Feng Z, Li JN, Li CZ, Peng X, Guo CB (2014) Prognostic factors of squamous cell carcinoma of the buccal mucosa: a retrospective study of 168 cases in North China. J Oral Maxillofac Surg 72(11):2344–2350
Sieczka E, Datta R, Singh A, Loree T, Rigual N, Orner J, Hicks W Jr (2001) Cancer of the buccal mucosa: are margins and T-stage accurate predictors of local control? Am J Otolaryngol 22(6):395–399
Anderson CR, Sisson K, Moncrieff M (2015) A meta-analysis of margin size and local recurrence in oral squamous cell carcinoma. Oral Oncol 51(5):464–469
Krishnan Nair M, Sankaranarayanan R, Padmanabhan TK (1988) Evaluation of the role of radiotherapy in the management of carcinoma of the buccal mucosa. Cancer 61(7):1326–1331
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
The Institutional Ethical Committee clearance was obtained.
Conflict of Interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Riju, J., George, N.A. Factors Influencing Locoregional Recurrence and Disease-Free Survival in Buccal Mucosal Squamous Cell Carcinoma. Indian J Surg 82, 57–61 (2020). https://doi.org/10.1007/s12262-019-01894-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12262-019-01894-4