PROGNOSIS AND MULTIVARIANT ANALYSIS OF N2c NODAL DISEASE IN ORAL CAVITY SQUAMOUS CELL CARCINOMA: A 10 YEAR STUDY IN TERTIARY CANCER CENTRE IN SOUTH INDIA.

Dr. Subbiah Shanmugham; Prof. G. Gopu; Dr. Syed Afroze Hussain; Dr. A. Jagadish Singh

Volume : VII, Issue : X, October - 2018

PROGNOSIS AND MULTIVARIANT ANALYSIS OF N2c NODAL DISEASE IN ORAL CAVITY SQUAMOUS CELL CARCINOMA: A 10 YEAR STUDY IN TERTIARY CANCER CENTRE IN SOUTH INDIA.

Dr. Subbiah Shanmugham, Prof. G. Gopu, Dr. Syed Afroze Hussain, Dr. A. Jagadish Singh

Abstract :

CONTEXT:

Surgery plays a pivotal role in the management of advanced oral cancers. The incidence of contralateral nodal disease in oral cavity squamous cell carcinomais quite predictable in relation with certain variables, helping us in addressing this nodal disease. The mortality associated with N2c disease is relatively high, hence optimising the treatment of N2c disease can have impact in the survival in certain subset of patients.

AIM:

The aim is to identify the clinico–pathological factors associated with N2c nodal disease and mortality associated with the disease.

MATERIALS AND METHODS:

A retrospective audit of 484 oral Squamous Cell Carcinoma (SCC) patients treated at Royapettah cancer centre, Chennai from 2007–2017. All cases with N2c disease (39patients) at presentation /relapsed at opposite node were analysed. The parameters analysed were anatomical subset in oral cavity, age(50 yr), gender, tobacco habits, midline crossing tumors, skin/bone involvement of primary tumor, ipsilateral nodal characteristics.

RESULTS:

Mortality with N2c disease was nearly 72.5% in our series. Among the oral cancers tongue buccal mucosa and floor of mouth subsets cancer were significantly associated with N2c disease whereas alveolus, palate were not significant. Midline crossing tumors were the single most independent factor significantly associated with N2c disease. T3 and above tumors were also significantly associated. Ipsilateralnode parameters like pathological positivity and multiplicity were significant in determining the N2c disease, (size of 3–6cm were 19/39, multiple nodal positivity (≥4 nodes) 4/39, pathological nodal positivity was 9/39).In our audit we found 26:13 M:F ratio. Almost all(~100%) of them had tobacco abuse history.

CONCLUSION:

N2c nodal disease is associated with mortality rate nearly equal to distant metastases in our study. By identifying the parameters associated with development of N2c disease and initiating appropriate treatment early we can achieve better survival in certain subset of patients.