• 8/11/2003
  • New York
  • Reuters Health

In patients with squamous cell carcinoma of the oral tongue (SCCOT), pathologic lymph node staging based on neck dissection is more reliable in predicting treatment outcomes than clinical lymph node staging based on physical examination and/or radiographic studies.

That’s according to Dr. Jeffrey N. Myers from M.D. Anderson Cancer Center in Houston and others who retrospectively reviewed all 266 patients who underwent surgical resection for SCCOT including a neck dissection.

In analyses comparing clinical outcomes with respect to clinical and pathologic lymph node stages, statistically significant differences in survival emerged for both clinical (cN0-N2) and pathologic (pN0-N2) stages.

However, the differences in survival and disease-free interval reached a higher level of statistical significance for pathologic lymph node staging (p < 0.0001) than for clinical lymph node staging (p < 0.002).

“This disparity can be explained by stage migration,” according to the team. That is, patients with cN0-1 disease had a more advanced lymph node stage at the time of pathologic review, they explain in the August 1 issue of the journal Cancer.

Neck dissection identified occult lymph node disease in 34 percent of the cN0 group, with extracapsular spread in 19 percent. Moreover, 43 percent of cN1 patients had greater than pN2b disease and 50 percent had extracapsular spread on pathologic review.

“For patients with tongue cancer, we can more accurately determine their prognosis by performing a neck dissection and analyzing the pathology specimen than we can by assessing the lymph node status purely on physical examination and/or radiographic studies,” Dr. Myers told Reuters Health.

“When we use physical examination or radiographic studies, we often underestimate the disease burden (though we sometimes overestimate it) and undertreat our patients,” he said.

“Obviously, more extensive surgery means more potential risk and possible morbidity for the patient,” Dr. Myers acknowledged. “However, we feel that in well trained, experienced hands this risk and morbidity are acceptably low and that neck dissection is justified as it allows us to more accurately treat and assess a patient’s prognosis and therefore more rationally select adjuvant therapies such as radiation and chemotherapy.”