Is the Depth of Invasion a Marker for Elective Neck Dissection in Early Oral Squamous Cell Carcinoma?

Yassine Aaboubout; Quincy M van der Toom; Maria A J de Ridder; Maria J De Herdt; Berdine van der Steen; Cornelia G F van Lanschot; Elisa M Barroso; Maria R Nunes Soares; Ivo Ten Hove; Hetty Mast; Roeland W H Smits; Aniel Sewnaik; Dominiek A Monserez; Stijn Keereweer; Peter J Caspers; Robert J Baatenburg de Jong; Tom C Bakker Schut; Gerwin J Puppels; José A Hardillo; Senada Koljenović

doi:10.3389/fonc.2021.628320

Is the Depth of Invasion a Marker for Elective Neck Dissection in Early Oral Squamous Cell Carcinoma?

Front Oncol. 2021 Mar 12:11:628320. doi: 10.3389/fonc.2021.628320. eCollection 2021.

Authors

Yassine Aaboubout^{1

2}, Quincy M van der Toom², Maria A J de Ridder³, Maria J De Herdt², Berdine van der Steen², Cornelia G F van Lanschot², Elisa M Barroso^{1

4

5}, Maria R Nunes Soares^{1

5}, Ivo Ten Hove⁴, Hetty Mast⁴, Roeland W H Smits², Aniel Sewnaik², Dominiek A Monserez², Stijn Keereweer², Peter J Caspers⁵, Robert J Baatenburg de Jong², Tom C Bakker Schut⁵, Gerwin J Puppels⁵, José A Hardillo², Senada Koljenović¹

Affiliations

¹ Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
² Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
³ Department of Medical informatics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
⁴ Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
⁵ Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.

Abstract

Objective: The depth of invasion (DOI) is considered an independent risk factor for occult lymph node metastasis in oral cavity squamous cell carcinoma (OCSCC). It is used to decide whether an elective neck dissection (END) is indicated in the case of a clinically negative neck for early stage carcinoma (pT1/pT2). However, there is no consensus on the cut-off value of the DOI for performing an END. The aim of this study was to determine a cut-off value for clinical decision making on END, by assessing the association of the DOI and the risk of occult lymph node metastasis in early OCSCC.

Methods: A retrospective cohort study was conducted at the Erasmus MC, University Medical Centre Rotterdam, The Netherlands. Patients surgically treated for pT1/pT2 OCSCC between 2006 and 2012 were included. For all cases, the DOI was measured according to the 8^th edition of the American Joint Committee on Cancer guideline. Patient characteristics, tumor characteristics (pTN, differentiation grade, perineural invasion, and lymphovascular invasion), treatment modality (END or watchful waiting), and 5-year follow-up (local recurrence, regional recurrence, and distant metastasis) were obtained from patient files.

Results: A total of 222 patients were included, 117 pT1 and 105 pT2. Occult lymph node metastasis was found in 39 of the 166 patients who received END. Univariate logistic regression analysis showed DOI to be a significant predictor for occult lymph node metastasis (odds ratio (OR) = 1.3 per mm DOI; 95% CI: 1.1-1.5, p = 0.001). At a DOI of 4.3 mm the risk of occult lymph node metastasis was >20% (all subsites combined).

Conclusion: The DOI is a significant predictor for occult lymph node metastasis in early stage oral carcinoma. A NPV of 81% was found at a DOI cut-off value of 4 mm. Therefore, an END should be performed if the DOI is >4 mm.

Keywords: depth of invasion; elective neck dissection; occult metastasis; oral cancer; squamous cell carcinoma of head and neck.

Copyright © 2021 Aaboubout, van der Toom, de Ridder, De Herdt, van der Steen, van Lanschot, Barroso, Nunes Soares, ten Hove, Mast, Smits, Sewnaik, Monserez, Keereweer, Caspers, Baatenburg de Jong, Bakker Schut, Puppels, Hardillo and Koljenović.