The significance of DNA flow cytometry in predicting survival and delayed clinical manifestation of occult lymph node metastasis to the untreated neck in patients with oral squamous cell carcinoma.
A total number of 116 clinically neck-negative patients with squamous cell carcinoma of the oral cavity who underwent radical primary tumour surgery without simultaneous neck treatment were entered into this prospective study. The 5 year overall survival rate was 87% for patients with flow cytometrically diploid tumours and 58% for the aneuploid group (P < 0.05). By multivariate survival analysis, tumour stage (P < 0.05) and DNA ploidy (P < 0.05) were significantly associated with the outcome. The cumulative 3 year rate of delayed clinical manifestation of lymph node metastasis to the previously untreated neck was 12.6% for patients with flow cytometrically diploid tumours and 41.3% for the aneuploid group (P < 0.01). By multivariate analysis, the DNA ploidy status of the primary tumour was the only factor among tumour stage, localization and degree of histological differentiation predictive of occult metastasis development (P < 0.05). Also, patients with T1 tumours who frequently are not considered to benefit from elective neck dissection were at high risk of subclinical lymph node involvement if the primary tumours were aneuploid (47%), whereas only 10% of the diploid T1 sample showed occult neck disease. Particularly in patients with less extensive oral carcinomas, DNA aneuploidy is therefore an important decisive factor in elective neck dissection.
Division of Tumour Biology, University of Ulm, Germany. joerg.hemmer@medizin.uni-ulm.de
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Hemmer
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Kraft
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Kreidler
D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D004273:DNA, Neoplasm / Q000032:analysis*; D005434:Flow Cytometry / Q000379:methods; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology / Q000556:secondary*; D006801:Humans; D008207:Lymphatic Metastasis; D009062:Mouth Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015999:Multivariate Analysis; D009333:Neck; D009367:Neoplasm Staging; D009382:Neoplasms, Unknown Primary / Q000401:mortality* / Q000473:pathology; D011003:Ploidies; D011379:Prognosis; D016019:Survival Analysis
D004273:DNA, Neoplasm