The Association Between Stage, Grade and Cervical Node Metastasis In Oral Cancer - A Single Institute Retrospective Study

Introduction: OSCCs have a peculiar reputation for their affinity to the lymphatics and are notorious for spreading to deep cervical lymphatics. It is a well known fact by now that the mere presence of cervical metastasis would reduce the 5 year survival rate by an astonishing 50 percent. There is still some persisting controversy in this crucial area of treatment planning of a clinically N0 neck. From a wait and watch policy to doing a sentinel biopsy to performing an elective neck dissection, the opinions are changing by the day. Aims and objective: The Aim of the study was to see the presence of any association between clinical and pathological indicators and cervical metastasis in patients having Oral Squamous Cell Carcinoma. Materials and methods: Retrospective analysis of case sheets and post operative histopathology reports of patients operated in our College from 2015-2017 were done and all the data related to cervical metastasis was noted. We classified cervical metastasis in to two groups: positive for cases with histological evidence of cervical metastasis and negative for those with no histological evidence. All patients were clinically staged according to the AJCC 7th edition guidelines. Known clinical and pathological indicators, in addition to the clinical staging were analysed to find out if they were predictive of neck disease using the chi square test. The survival time was calculated using Kaplan-Meier survival curve only wherever necessary. The log rank test was used to detect the differences for survival time. We compared this data with the previously available literature. Results: The likelihood of performing an MRND with a higher T and N stage is statistically significant with a p value of < 0.001. There was no significant association between TNM staging, histological grade and the presence of cervical metastasis. Though the survival is more in patients with no nodal disease, it is statistically not significant (p= 0.620) in Chi square test and in Kaplar-Meier analysis (p= 0.340). A similar result was obtained for disease free survival analysis also (p=0.115 in Chi square test and p= 0.081 in Kaplar-Meier analysis). Conclusion: There seems to be no significant association between known clinical and pathological indicators and the likelihood of a patient having cervical metastasis.