title: Causes of oral tongue cancer treatment failures. Analysis of autopsy cases.
abstract: Eighty-three autopsy cases of squamous cell carcinoma of the oral tongue were reviewed to identify retrospectively the causes of treatment failure. The cure rate for the primary cancers at autopsy was 48.2% (40 of 83). Regional lymph node metastases were found in 71.1% (59 of 83). Regional metastases and/or juxtaprimary recurrence frequently spread continuously and diffusely, forming bulky neck tumors in 38.6% (32 of 83). The incidence of distant lymph node metastasis (below the clavicle) and hematogenous metastasis was 35.4% (29 of 82) and 58.5% (48 of 82), respectively. The lung was the most common site of hematogenous metastases (52.4%, 43 of 82). Hematogenous metastasis occurred more frequently in the younger age group (less than 40 years of age; P = 0.03). Distant lymph node metastases were identified in the lung hilar, bifurcation, and paratracheal nodes in 89.7% (26 of 29) and had a statistically significant association with lung hematogenous metastasis. Univariate analysis revealed that gross appearance, tumor stage, clinical stage, presence of cervical lymph node metastasis, and interval from N0 to NX were significant predictors of survival time (duration from initial treatment to death). Rupture of the neck vessels was fatal in eight patients (9.6%), and hypercalcemia was seen in six (7.2%). Pulmonary infection was the direct cause of death in 33.7% of patients (28 of 83). Secondary malignant lesions occurred in 22.9% (19 of 83).
authors.affiliation: Department of Oral Pathology, Faculty of Dentistry, Tokyo Medical and Dental University, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Takagi
authors.forename: T
authors.initials: T
authors.lastname: Kayano
authors.forename: H
authors.initials: H
authors.lastname: Yamamoto
authors.forename: H
authors.initials: H
authors.lastname: Shibuya
authors.forename: M
authors.initials: M
authors.lastname: Hoshina
authors.forename: S
authors.initials: S
authors.lastname: Shioda
authors.forename: S
authors.initials: S
authors.lastname: Enomoto
mesh_terms: D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000556:secondary / Q000628:therapy; D002423:Cause of Death; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology; D008175:Lung Neoplasms / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary; D012189:Retrospective Studies; D016019:Survival Analysis; D014062:Tongue Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D016896:Treatment Outcome