Cornelia G F van Lanschot1, Yoram P Klazen2, Maria A J de Ridder3, Hetty Mast4, Ivo Ten Hove5, José A Hardillo6, Dominiek A Monserez7, Aniel Sewnaik8, Cees A Meeuwis9, Stijn Keereweer10, Yassine Aaboubout11, Elisa M Barroso12, Quincy M van der Toom13, Tom C Bakker Schut14, Eppo B Wolvius15, Robert J Baatenburg de Jong16, Gerwin J Puppels17, Senada Koljenović18. 1. Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands. Electronic address: c.vanlanschot@erasmusmc.nl. 2. Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands. Electronic address: y.klazen@erasmusmc.nl. 3. Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands. Electronic address: m.deridder@erasmusmc.nl. 4. Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands. Electronic address: h.mast@erasmusmc.nl. 5. Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands. Electronic address: i.tenhove@erasmusmc.nl. 6. Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands. Electronic address: j.hardillo@erasmusmc.nl. 7. Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands. Electronic address: d.monserez@erasmusmc.nl. 8. Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands. Electronic address: a.sewnaik@erasmusmc.nl. 9. Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands. Electronic address: ceesmeeuwis@icloud.com. 10. Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands. Electronic address: s.keereweer@erasmusmc.nl. 11. Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Pathology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands. Electronic address: y.aaboubout@erasmusmc.nl. 12. Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Pathology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands. Electronic address: e.barroso@erasmusmc.nl. 13. Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands. 14. Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands. Electronic address: t.bakkerschut@erasmusmc.nl. 15. Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands. Electronic address: e.wolvius@erasmusmc.nl. 16. Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands. Electronic address: r.j.baatenburgdejong@erasmusmc.nl. 17. Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands. Electronic address: gpuppels@riverd.com. 18. Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Pathology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands. Electronic address: s.koljenovic@erasmusmc.nl.
Abstract
OBJECTIVES: Depth of invasion (DOI) is the most important predictor for lymph node metastasis (LNM) in early stage (T1-T2) oral cancer. The aim of this study is to validate the cut-off value of 4 mm on which the decision to perform an Elective Neck Dissection (END) is made. MATERIALS AND METHODS: We performed a retrospective study in patients with pathologically proven early stage oral cavity squamous cell carcinoma (OCSCC) without clinical or radiological signs of LNM, who were treated between 2013 and 2018. An END was performed when DOI was ≥ 4 mm and a watchful waiting protocol was applied in patients with DOI < 4 mm. RESULTS: Three hundred patients were included. END was performed in 77% of patients with DOI ≥ 4 mm, of which 36% had occult LNM (pN+). Patients in the watchful waiting group (48%) developed a regional recurrence in 5.2% for DOI < 4 mm and 24.1% for DOI ≥ 4 mm. For DOI ≥ 4 mm, regional recurrence free survival was higher for patients who were treated with END compared to watchful waiting (p = 0.002). A Receiver-Operator-Curve -analysis showed that a DOI cut-off value of 4.0 mm was the optimal threshold for the prediction of occult LNM (95.1% sensitivity, 52.9% specificity). CONCLUSION: A DOI of ≥ 4 mm is an accurate cut-off value for performing an END in early stage OCSCC. END results in higher survival rates and lower regional recurrence rates in patients with DOI ≥ 4 mm.
OBJECTIVES: Depth of invasion (DOI) is the most important predictor for lymph node metastasis (LNM) in early stage (T1-T2) oral cancer. The aim of this study is to validate the cut-off value of 4 mm on which the decision to perform an Elective Neck Dissection (END) is made. MATERIALS AND METHODS: We performed a retrospective study in patients with pathologically proven early stage oral cavity squamous cell carcinoma (OCSCC) without clinical or radiological signs of LNM, who were treated between 2013 and 2018. An END was performed when DOI was ≥ 4 mm and a watchful waiting protocol was applied in patients with DOI < 4 mm. RESULTS: Three hundred patients were included. END was performed in 77% of patients with DOI ≥ 4 mm, of which 36% had occult LNM (pN+). Patients in the watchful waiting group (48%) developed a regional recurrence in 5.2% for DOI < 4 mm and 24.1% for DOI ≥ 4 mm. For DOI ≥ 4 mm, regional recurrence free survival was higher for patients who were treated with END compared to watchful waiting (p = 0.002). A Receiver-Operator-Curve -analysis showed that a DOI cut-off value of 4.0 mm was the optimal threshold for the prediction of occult LNM (95.1% sensitivity, 52.9% specificity). CONCLUSION: A DOI of ≥ 4 mm is an accurate cut-off value for performing an END in early stage OCSCC. END results in higher survival rates and lower regional recurrence rates in patients with DOI ≥ 4 mm.
Authors: Yassine Aaboubout; Quincy M van der Toom; Maria A J de Ridder; Maria J De Herdt; Berdine van der Steen; Cornelia G F van Lanschot; Elisa M Barroso; Maria R Nunes Soares; Ivo Ten Hove; Hetty Mast; Roeland W H Smits; Aniel Sewnaik; Dominiek A Monserez; Stijn Keereweer; Peter J Caspers; Robert J Baatenburg de Jong; Tom C Bakker Schut; Gerwin J Puppels; José A Hardillo; Senada Koljenović Journal: Front Oncol Date: 2021-03-12 Impact factor: 6.244
Authors: Maria J De Herdt; Berdine van der Steen; Quincy M van der Toom; Yassine Aaboubout; Stefan M Willems; Marjan H Wieringa; Robert J Baatenburg de Jong; Leendert H J Looijenga; Senada Koljenović; Jose A Hardillo Journal: Front Oncol Date: 2021-04-29 Impact factor: 6.244
Authors: Marta Filauro; Francesco Missale; Filippo Marchi; Andrea Iandelli; Andrea Luigi Camillo Carobbio; Francesco Mazzola; Giampiero Parrinello; Emanuele Barabino; Giuseppe Cittadini; Davide Farina; Cesare Piazza; Giorgio Peretti Journal: Eur Arch Otorhinolaryngol Date: 2020-10-21 Impact factor: 2.503