West China Journal of Stomatology ›› 2022, Vol. 40 ›› Issue (4): 422-427.doi: 10.7518/hxkq.2022.04.008

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Clinical study on the pattern of lower-level lymphatic metastasis in primary tongue squamous cell carcinoma

Yang Yunbo1(), Han Nannan2, Wang Yupu2, Li Huasheng2, Yan Ming2, Li Siyi2, Ruan Min2(), Zhang Chenping2   

  1. 1.School of Stomatology, Weifang Medical University, Weifang 261053, China
    2.Dept. of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
  • Received:2022-02-08 Revised:2022-04-28 Online:2022-07-25 Published:2022-07-27
  • Contact: Ruan Min E-mail:565350445@qq.com;doctorruanmin@sjtu.edu.cn
  • Supported by:
    The National Natural Science Foundation of China(82072983);Shanghai Medical Garden Rising Star Talent Program (Hu[2021]No. 99). Correspondence: Ruan Min, E-mail: doctorruanmin@sjtu.edu.cn


Objective To study and analyze the clinical patterns of lower-level lymph node (Ⅳ and Ⅴ) metastasis in primary tongue squamous cell carcinoma, and establish a reference for the decision-making of the lower-level neck dissection in tongue squamous cell carcinoma. Methods A total of 203 patients with primary tongue squamous cell carcinoma were recruited. These patients underwent simultaneous/secondary comprehensive neck (level Ⅰ-Ⅴ) dissection in Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine from January 2010 to December 2015. Their clinicopathological and follow-up data were obtained and analyzed to reveal the prognosis and risk factors of primary tongue squamous cell carcinoma with lower-level lymph node metastasis. Results Among the 203 patients, the metastasis rates of levels Ⅳ and Ⅴ are 14.78% and 4.93%, respectively. Level Ⅳ metastasis is more prevalent in males than females (P=0.04); non-smokers are more likely to have level Ⅴ metastasis than smokers (P=0.046). Lymph node status in levels Ⅲ and Ⅳ are significantly associated with the risk of metastasis in level Ⅴ (P=0.001). Patients with extracapsular invasion in level Ⅲ have a significantly increased risk of metastasis in levels Ⅳ (P=0.014) and Ⅴ (P=0.026). The 5-year survival rate of patients with lower lymph node (Ⅳ/Ⅴ) metastasis is only 14.70%, which is an independent poor prognostic factor for patients with primary tongue squamous cell carcinoma (P<0.000 1). Conclusion Most primary tongue squamous cell carcinoma metastases occur in levels Ⅰ-Ⅲ. However, the rate of lower-level lymph node metastasis is rather low. For the cN0 and cN+ patients with levels Ⅰ-Ⅱ lymph node metastases without extracapsular invasion, the strategy for level Ⅴ management may be observation rather than dissection.

Key words: tongue squamous cell carcinoma, lymph node metastasis, neck dissection, level Ⅴ, extracapsular invasion

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