title: Prediction of delayed neck metastasis in patients with stage I/II squamous cell carcinoma of the tongue.
abstract: BACKGROUND
  The incidence of delayed neck metastasis (DNM) in patients with squamous cell carcinoma (SCC) of the tongue is reported to be 20% to 50%. Although clinically negative cervical lymph nodes (N0) are associated with a good outcome, the prognosis is poor in patients with DNM. The aim of this study was to evaluate the clinicopathological and immunohistochemical parameters associated with DNM in patients with stage I/II SCC.
  
  
  METHODS
  Fifty nine patients, with previously untreated stage I/II carcinoma, underwent examination of clinicopathological and immunohistochemical parameters and incidence of DNM. A linear discriminant analysis was used to analyze prognostic factors and to determine the probability of DNM occurring.
  
  
  RESULTS
  DNM occurred in 14 (24%) subjects of the 59 study patients, level I to level III, within 5 years. Parameters such as gender and age, disease stage, tumor size and histological grade, tumor location, degree of tumor invasion and expression of VEGF, E-cadherin or Ki-67 showed no significant correlation with the occurrence of DNM; however, factors such as tumor morphology, tumor thickness greater than 4 mm, and Flt-4 expression were significantly associated with development of DNM.
  
  
  CONCLUSIONS
  Such factors provide useful information with regard to DNM and the prognosis. We concluded that patients with early SCC whose tumors are > 4 mm in thickness and immunopositive for Flt-4 are particularly at risk of developing DNM.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan. masumi8148@hotmail.com
authors.forename: Masumi
authors.initials: M
authors.lastname: Okamoto
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Nishimine
authors.forename: Munehiro
authors.initials: M
authors.lastname: Kishi
authors.forename: Tadaaki
authors.initials: T
authors.lastname: Kirita
authors.forename: Masahito
authors.initials: M
authors.lastname: Sugimura
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Nakamura
authors.forename: Noboru
authors.initials: N
authors.lastname: Konishi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D015820:Cadherins / Q000032:analysis; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000556:secondary*; D016009:Chi-Square Distribution; D016002:Discriminant Analysis; D016228:Endothelial Growth Factors / Q000032:analysis; D005260:Female; D005544:Forecasting; D006801:Humans; D019394:Ki-67 Antigen / Q000032:analysis; D016014:Linear Models; D008207:Lymphatic Metastasis / Q000473:pathology*; D008222:Lymphokines / Q000032:analysis; D008297:Male; D008875:Middle Aged; D009333:Neck; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D020033:Protein Isoforms / Q000032:analysis; D020794:Receptor Protein-Tyrosine Kinases / Q000032:analysis; D017978:Receptors, Growth Factor / Q000032:analysis; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis; D013997:Time Factors; D014062:Tongue Neoplasms / Q000473:pathology*; D042461:Vascular Endothelial Growth Factor A; D040321:Vascular Endothelial Growth Factor Receptor-3; D042442:Vascular Endothelial Growth Factors
chemical_list: D014408:Biomarkers, Tumor; D015820:Cadherins; D016228:Endothelial Growth Factors; D019394:Ki-67 Antigen; D008222:Lymphokines; D020033:Protein Isoforms; D017978:Receptors, Growth Factor; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors; D020794:Receptor Protein-Tyrosine Kinases; D040321:Vascular Endothelial Growth Factor Receptor-3