Homi Bhabha Cancer Hospital and Research Centre Visakhapatnam, Andhra Pradesh
R. A. Vadgaonkar1, S. S. Nayak1, S. K. Kavutarapu1, A. Dutta1, N. Noothanapati1, N. Alapati1, S. Nachu1, V. R. Bandal1, P. Chauhan1, C. Pusarala1, C. S. Dravid2, V. Viswanath1, R. Miriyala1, and U. M. Mahantshetty1; 1Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam, India, 2Tata Memorial Hospital, Mumbai, India
Purpose/Objective(s): Study aimed is to assess topographical distribution, failure patterns, and prognostic factors affecting outcomes of Oral Squamous Cell Carcinoma (OSCC) patients positive neck nodes with extracapsular extension (ECE). Materials/
Methods: This is a single institute experience of consecutive OSCC cases having pathologically positive neck nodes with ECE operated with a curative intent between January 1, 2018, to December 31, 2022. Data were extracted from available electronic medical records, and treatment summaries. Results: Among the 606 patients with OSCC who underwent curative surgery, 298 (49.2%) showed neck nodal positivity, with 142 (47.7%) exhibiting ECE. Median age of the cohort was 49 years and men comprising 113 (79.6%) of total. Primary tumor sites were distributed as: buccal mucosa/gingivo-buccal sulcus/retromolar trigone (group 1): 74 (52.1%), oral tongue and floor of mouth (group 2): 59 (41.5%), and hard palate (group 3): 9 (6.3%). Most common surgical procedures for primary comprised composite resection in 69 (48.6%). Bilateral neck dissection (BND) was performed in 68 (47.9%) and unilateral (UND) in 74 (52.1%). Except for two, all cases had negative margins. The median lymph node yield was 81 in BND and 40 in UND, with a median of 4 positive nodes. The nodal regions most commonly involved with ECE were IB (80%), II (58%), and II (78%) for groups 1, 2, and 3, respectively. Adjuvant chemo-RT was administered to 103 (72.5%). At a median follow-up of 35 months, 58 (4.08%) experienced treatment failures, including isolated local (LF) in 15 (10.6%), isolated regional (RF) in 11 (7.7%), loco-regional (LRF) in 10 (7%), isolated distant in 10 (7%), local with distant in 5 (3.5%), and regional with distant in 7 (4.9%). A total 9 (6.3%) had failure within 6 weeks of surgery and before initiating adjuvant treatment. Among LFs, 24 (80%) were observed within reconstructed flap or tumor bed, in infra-temporal fossa and/ or skull base in 6 (20%). In RFs, 20 (71.4%) occurred in dissected nodal levels and 8 (42.1%) were seen in the same level as that of initial involvement with ECE. RF was observed in the undissected contralateral neck in 8 (28.6%) cases having group 1 primary. The 2-year LRC, DFS, and OS were 34%, 34%, and 39%, respectively. Multivariate analysis revealed poorer 2-year LRC and DFS for neck nodal involvement with ECE at level IV/V and overall treatment time (OTT) of > 85 days. Inferior 2-year OS was associated with group 2 and 3 primaries, a non-cohesive pattern of invasion, and OTT of > 85 days. Conclusion: This study represents one of the largest investigations into landscape of node positive oral cancer patients having ECE depicting a comprehensive patterns of failure and warrants a more aggressive local as well systemic approach. It also offers valuable insights into the prognostic factors linked with ECE, thereby enhancing understanding of this scenario.
