Lymph node density as a prognostic predictor in patients with betel nut-related oral squamous cell carcinoma

• Main Authors: Chang, W.-C (Author), Chen, Y.-W (Author), Lin, C.-K (Author), Lin, C.-S (Author), Yang, C.-Y (Author)
• Format: Article
• Language: English
• Published: Springer Verlag 2018
• Subjects: adult; Adult; aged; Aged; Aged, 80 and over; Areca; Betel nut; cancer staging; Carcinoma, Squamous Cell; chemically induced; disease exacerbation; Disease Progression; female; Female; human; Humans; Lymph node density; lymph node metastasis; Lymphatic Metastasis; male; Male; middle aged; Middle Aged; Mouth Neoplasms; mouth tumor; Neoplasm Staging; Oral squamous cell carcinoma; pathology; prognosis; Prognosis; Prognostic factor; Retrospective Studies; retrospective study; squamous cell carcinoma; survival rate; Survival Rate; very elderly
• Online Access: View Fulltext in Publisher

 Objectives: Lymph node metastasis in oral squamous cell carcinoma (OSCC) is a poor prognostic factor. The histopathologic stage (e.g., pN) is used to evaluate the severity of lymph node metastasis; however, the current staging system insufficiently predicts survival and recurrence. We investigated clinical outcomes and lymph node density (LND) in betel nut-chewing individuals. Material and methods: We retrospectively analyzed 389 betel nut-exposed patients with primary OSCC who underwent surgical resection in 2002–2015. The prognostic significance of LND was evaluated by overall survival (OS) and disease-free survival (DFS) using the Kaplan-Meier method. Results: Kaplan-Meier analyses showed that the 5-year OS and DFS rates in all patients were 60.9 and 48.9%, respectively. Multivariate analysis showed that variables independently prognostic for OS were aged population (hazard ratio [HR] = 1.6, 95% confidence interval [95% CI] = 1.1–2.5; P = .025), and cell differentiation classification (HR = 2.4, 95% CI = 1.4–4.2; P = .002). In pathologic N-positive patients, a receiver operating characteristic (ROC) curve for OS was used and indicated the best cutoff of 0.05, and the multivariate analysis showed that LND was an independent predictor of OS (HR = 2.2, 95% CI = 1.3–3.7; P = .004). Conclusions: Lymph node density, at a cutoff of 0.05, was an independent predictor of OS and DFS. OS and DFS underwent multiple analyses, and LND remained significant. The pathologic N stage had no influence in the OS analysis. Clinical relevance: LND is a more reliable predictor of survival in betel nut-chewing patients for further post operation adjuvant treatment, such as reoperation or adjuvant radiotherapy. © 2017, The Author(s).