Nodal Metastasis in Oral Squamous Cell Carcinoma: Predictive Impact of MRI-Derived Depth of Invasion According to the 8th Edition American Joint Committee on Cancer Staging System
International journal of radiation oncology, biology, physics(2019)
摘要
To evaluate the relationship between the magnetic resonance imaging (MRI)-derived depth of invasion (DOI) and nodal recurrence in clinically node-negative patients with oral squamous cell carcinoma (SCC). The institutional review board approved this retrospective study. The study population consisted of 90 patients with clinical T1-2N0 oral SCC classified according to the 7th edition American Joint Committee on Cancer (AJCC) staging system; 41 were staged as T1N0 and 49 as T2N0. They (55 males and 35 females; median age, 70 years; age range, 29 - 92 years) had undergone routine pretreatment radiological examinations including MRI and 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) fused imaging. The clinical pretreatment stage had been identified at a routine preoperative conference; the radiological diagnosis of nodal involvement was based on accepted morphologic criteria and FDG uptake. The primary tumors were located in the buccal mucosa (n = 4), upper gingiva (n = 11), lower gingiva (n = 12), hard palate (n = 3), tongue (n = 52), and floor of the mouth (n = 8). All patients were treated with local resection alone as primary treatment and watchful waiting for neck management. We reviewed DOI on pretreatment MRI and reclassified T stage according to the 8th edition AJCC. During the median follow-up period of 36 months (range, 2 - 122 months), the initial sites of recurrence were classified as local, nodal, and distant. Using Student's t-test and Pearson's chi-squared test, the MRI-derived DOI and T stage according to the 7th and 8th editions were assessed as predictive factors for nodal recurrence. The MRI-derived DOI was recorded as ≤ 5 mm in 42-, 5-10 mm in 37-, and > 10 mm in 11 patients. According to the 8th edition, 22 tumors were T1, 61 were T2, and 7 were T3 stage. During the follow-up period, 11 and 16 patients, respectively, suffered local and nodal recurrence; there were no patients with distant recurrence. The mean (± standard deviation) value of the MRI-derived DOI was significantly higher in the patients with nodal recurrence (8.4 ± 2.4 mm) than the others (4.7 ± 3.4 mm) (p < 0.001). The MRI-derived DOI classified significantly different risk groups for nodal recurrence; the incidence was 2% for tumor ≤ 5mm, 27% for 5-10 mm, and 46% for > 10 mm (p = 0.001). T stage according to the 8th edition also predicted the nodal recurrence; the incidence was 0% for T1, 21% for T2, and 43% for T3 stage (p = 0.016). However, T stage according to the 7th edition was not a significant factor for the nodal recurrence; no factors predicted the local recurrence. The MRI-derived DOI can predict nodal metastasis and the information may assist in treatment planning for oral SCC.
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