Incidence and impact of skip metastasis in the neck in early oral cancer: Reality or a myth?. (December 2022)

• Record Type: Journal Article
• Authors: Gurmeet Singh, Arjun; Sathe, Pranav; Roy, Satadru; Thiagrajan, Shivakumar; Chaukar, Devendra; Chaturvedi, Pankaj
• Is Part Of: Oral oncology. Volume 135(2022)
• Publication Date: 2022-12
• Subjects: Early oral cancer -- Level IV -- Skip metastasis -- Clinically node negative -- cN0; Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2022.106201
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: Occult metastasis was in 17.9% with 47.1% of this travelling to level I(b). Skip metastasis at level III was in 1.2% and level IV was 0.3% Presence of PNI predicted skip metastasis at level III. Isolated occult metastasis at level Ia was in 0.3%, all in tongue cancers. Clearance up to level III might be adequate in majority of patients. Abstract: Objectives: Varying evidence exists surrounding skip metastasis in clinically node-negative oral cancer. We aim to report its incidence, identify factors predicting its presence, and determine survival outcomes to possibly decide "adequacy" of neck dissection for this select group. Methods: A review of audit records (clinical and pathologic) was undertaken to identify early stage (cT1/T2 cN0) oral squamous carcinoma patients operated between January 2016 and December 2020. Skip metastasis was defined as presence of nodal metastases distant from the primary tumour and at a lower level without metastases at levels above this. The factors predicting its presence were determined using chi-square and multivariate tests. Survival analysis was performed using Kaplan-Meier and regression hazard models. Results: Occult metastasis rate was 17.9 % among 761 patients, with 47.1 % travelling to level I. Skip metastasis at level III was seen in 1.2 % and level IV was 0.3 %. Presence of PNI predicted the presence of skip metastasis at level III (p = 0.041, OR-0.241, 95 %CI 0.062–0.942) and no significant factors were identified for level IV. The 5-year disease-free survival was significantly reduced with isolated level IV metastasis (50 % vs 79.6 %, p = 0.017). Isolated occult metastasis at level Ia was in 0.3 %, all from tongue cancers. Their presence did not impact the 5-year overall survival (100 % vs 90.7 %, p = 0.628) and disease-specific survival (100 % vs 92.5 %, p = 0.675). Conclusion: The negligible incidence of skip metastasis to level IV in a clinically node negative neck suggests that clearance up to level III might be adequate in a large majority of patients.