Positive sentinel lymph nodes are a negative prognostic factor for survival in T1-2 oral/oropharyngeal cancer-a long-term study on 103 patients.
BACKGROUND
To evaluate prognostic value of sentinel node biopsy (SNB) in oral/oropharyngeal squamous cell cancer (OOSCC) concerning overall/disease-free survival.


METHODS
One hundred three consecutive patients with T1-2N0 OOSCC were consecutively recruited for SNB as single invasive staging method for the neck. Two hundred seventy-three sentinel nodes (SNs) were removed (mean, 2.65 per patient). Nine patients had 10 positive SNs (upstaging rate, 8.7%) found in levels I to III, leading to a therapeutic neck dissection.


RESULTS
Mean observation time of all patients was 6.7 years; mean survival time of patients with negative or positive SNs was 6.9 and 3.7 years, respectively. There has been no false-negative result of SNB to date becoming manifest in ipsilateral node metastasis during follow-up. Five-year overall/disease-free survival of all patients was 82%/72%, respectively. The same parameters for the patients with negative SNs were 85%/74%, for those with positive SNs 38%/47%, respectively (statistically significant). There has been a higher statistical risk for locoregional recurrence for patients with positive SNs. Rates of metachronous second primary tumors developing during follow-up were 10.6% (negative SNs) and 44.4% (positive SNs).


CONCLUSIONS
SNB was a valuable diagnostic method in patients with T1-2N0 OOSCC avoiding elective neck dissections. Patients with positive SNs had statistically significantly higher rates of locoregional recurrences, second primary tumors, tumor-related deaths, and a worse overall/disease-free survival. To date, no therapeutic consequences in case of a positive SN beyond execution of modified radical neck dissection (to remove other positive nodes) and closer attention during follow-up can be concluded from this study.
Kovács
Adorján F
AF
Department of Oral and Cranio-Maxillofacial Plastic Surgery, Johann Wolfgang Goethe University Medical School, Frankfurt am Main, Germany. a.kovacs@em.uni-frankfurt.de
Stefenelli
Ulrich
U
Seitz
Oliver
O
Middendorp
Marcus
M
Diener
Jürgen
J
Sader
Robert
R
Grünwald
Frank
F
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000556:secondary; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000401:mortality* / Q000473:pathology; D037981:Neck Dissection / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000401:mortality* / Q000473:pathology; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy; D015996:Survival Rate; D014055:Tomography, Emission-Computed; D016896:Treatment Outcome