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Prognostic Significance of the Metastatic Lingual Lymph Node in Oral Tongue and Floor of Mouth Squamous Cell Carcinoma

  • Oh Hyeong Lee
    Affiliations
    Clinical Fellow, Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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  • Uiju Cho
    Affiliations
    Clinical Assistant Professor, Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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  • Jae Seong An
    Affiliations
    Resident, Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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  • Jung-Hae Cho
    Correspondence
    Address correspondence and reprint requests to Dr Cho: Department of Otolaryngology-Head and Neck Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93, Jungbu-daero, Paldal-Gu, Suwon-si, Gyeonggi-do 16247, Republic of Korea
    Affiliations
    Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Published:November 11, 2021DOI:https://doi.org/10.1016/j.joms.2021.11.003

      Purpose

      The lingual lymph node (LLN) located on the internal surface of mylohyoid muscle is not currently included in oral cavity cancer surgery or conventional neck dissection. We investigated the risk factors for LLN metastasis and evaluated its oncologic significance in patients with oral tongue and floor of mouth squamous cell carcinoma.

      Patients and Methods

      Adult patients (≥20 years) undergoing upfront surgery and LLN dissection for oral tongue and floor of mouth squamous cell carcinoma between 2009 and 2018 were retrospectively analyzed. Patients who had relapsed after previous treatment or had neoadjuvant chemotherapy or had not undergone surgery were excluded. Association between clinicopathological risk factors (age, gender, tumor differentiation, stage, lymphatic invasion, perineural invasion, vascular invasion, metastatic lymph node ratio, and extranodal extension) and LLN metastasis was evaluated using logistic regression analysis. Disease-free survival in accordance with LLN metastasis was evaluated by the Kaplan–Meier method.

      Results

      A total of 51 patients were included, and LLN metastasis was found in 9 patients (17.6%). LLN metastasis was significantly associated with advanced nodal stage, poor tumor differentiation, and vascular invasion. Cox proportional-hazards regression models showed that LLN metastasis was associated with an 8.0-fold higher risk of mortality than the absence of LLN metastasis. Patients with LLN metastasis had significantly worse 5-year disease-free survival rate than those without metastasis (22.2% vs 85.7%; P < .001).

      Conclusions

      This study suggests that LLN metastasis is a poor prognostic factor in patients with oral tongue and floor of mouth squamous cell carcinoma. The sublingual space should be carefully evaluated preoperatively and intraoperatively.
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      References

        • Balasubramanian D.
        • Thankappan K.
        • Battoo A.J.
        • et al.
        Isolated skip nodal metastasis is rare in T1 and T2 oral tongue squamous cell carcinoma.
        Otolaryngol Head Neck Surg. 2012; 147: 275
        • Ananian S.G.
        • Gvetadze S.R.
        • Ilkaev K.D.
        • et al.
        Anatomic-histologic study of the floor of the mouth: The lingual lymph nodes.
        Jpn J Clin Oncol. 2015; 45: 547
        • Nishio N.
        • Fujimoto Y.
        • Hiramatsu M.
        • et al.
        Sonographic detection of a lingual node metastasis from early squamous cell cancer of the tongue.
        J Clin Ultrasound. 2018; 46: 69
        • Rouviere H.
        Anatomy of the Human Lymphatic System.
        Ann Arbor, MI: Edwards Brother, Inc.,1938
        • Ozeki S.
        • Tashiro H.
        • Okamoto M.
        • et al.
        Metastasis to the lingual lymph node in carcinoma of the tongue.
        J Maxillofac Surg. 1985; 13: 277
        • Gvetadze S.R.
        • Ilkaev K.D.
        Lingual lymph nodes: Anatomy, clinical considerations, and oncological significance.
        World J Clin Oncol. 2020; 11: 337
        • Ho A.S.
        • Kim S.
        • Tighiouart M.
        • et al.
        Metastatic lymph node burden and survival in oral cavity cancer.
        J Clin Oncol. 2017; 35: 3601
        • Jia J.
        • Jia M.Q.
        • Zou H.X.
        Lingual lymph nodes in patients with squamous cell carcinoma of the tongue and the floor of the mouth.
        Head Neck. 2018; 40: 2383
        • Kikuchi M.
        • Harada H.
        • Asato R.
        • et al.
        Lingual lymph node metastases as a prognostic factor in oral squamous cell carcinoma-a retrospective multicenter study.
        Medicina (Kaunas). 2021; 57: 374
        • Ando M.
        • Asai M.
        • Ono T.
        • et al.
        Metastases to the lingual nodes in tongue cancer: A pitfall in a conventional neck dissection.
        Auris Nasus Larynx. 2010; 37: 386
        • Calabrese L.
        • Bruschini R.
        • Giugliano G.
        • et al.
        Compartmental tongue surgery: Long term oncologic results in the treatment of tongue cancer.
        Oral Oncol. 2011; 47: 174
        • Suzuki M.E.K.
        • Ida S.
        • Okada R.
        • et al.
        Lateral lingual lymph node metastasis in tongue cancer and the clinical classification of lingual lymph nodes.
        J Jpn Soc Head Neck Surg. 2016; 26: 71
        • Fang Q.
        • Li P.
        • Qi J.
        • et al.
        Value of lingual lymph node metastasis in patients with squamous cell carcinoma of the tongue.
        Laryngoscope. 2019; 129: 2527-2530
        • Saito M.
        • Nishiyama H.
        • Oda Y.
        • et al.
        The lingual lymph node identified as a sentinel node on CT lymphography in a patient with cN0 squamous cell carcinoma of the tongue.
        Dentomaxillofac Radiol. 2012; 41: 254
        • Calabrese L.
        • Renne G.
        • De Cicco C.
        • et al.
        Metastatic cancer to the floor of mouth: The lingual lymph nodes.
        Head Neck. 2003; 25: 341
        • DiNardo L.J.
        Lymphatics of the submandibular space: An anatomic, clinical, and pathologic study with applications to floor-of-mouth carcinoma.
        Laryngoscope. 1998; 108: 206
        • Bang J.
        • Jung W.S.
        • Cho J.H.
        Sonographic detection of a metastatic lingual lymph node in a patient with tongue cancer.
        J Clin Ultrasound. 2020; 48: 343
        • Mamic M.
        • Lucijanic M.
        • Manojlovic L.
        • et al.
        Prognostic significance of extranodal extension in oral cavity squamous cell carcinoma with occult neck metastases.
        Int J Oral Maxillofac Surg. 2021; 50: 309
        • Shaw R.J.
        • Lowe D.
        • Woolgar J.A.
        • et al.
        Extracapsular spread in oral squamous cell carcinoma.
        Head Neck. 2010; 32: 714
        • Eguchi K.
        • Kawai S.
        • Mukai M.
        • et al.
        Medial lingual lymph node metastasis in carcinoma of the tongue.
        Auris Nasus Larynx. 2020; 47: 158