title: Predictive factors of occult neck metastasis in patients with oral squamous cell carcinoma.
abstract: BACKGROUND
  It is well established that cervical lymph node metastasis is the most important prognostic factor in patients with oral squamous cell carcinoma of the upper aerodigestive tract. The definition of parameters and classifications that could separate patients in groups of low, intermediate and high-risk is being attempted for several years.
  
  
  OBJECTIVE
  The objective of this study was to determine possible predictive factors related to the occurrence of occult cervical lymph node metastasis through the analysis of histopathological reports of surgical specimens obtained after oral squamous cell carcinoma resection and selective neck dissections of patients initially classified as N0.
  
  
  METHODS
  This was a primary, retrospective, observational, case-control study. Histopathological reports were reviewed to determine if some findings were related to the occurrence of occult lymph node metastasis. The events analyzed were oral cavity subsites, pT-stage, muscular infiltration, desmoplasia, vascular emboli, perineural infiltration, tumor thickness and compromised margins.
  
  
  RESULTS
  Occult cervical metastasis accounted for 19.10 percent of the cases. Desmoplasia, perineural infiltration, tumor thickness and pT4a stage are predictive factors of occult neck metastasis (p-value=0.0488, 0.0326, 0.0395, 0.0488, respectively).
  
  
  CONCLUSIONS
  The accurate definition of predictive factors of occult cervical metastasis may guide the selection of patients that should be referred to radiotherapy, avoiding the unnecessary exposure of low-risk patients to radiation and allowing a better regional control of the disease in those of moderate or high risk.
authors.affiliation: Hospital do Servidor Público Estadual (IAMSPE), São Paulo, SP, Brazil. Electronic address: renatobittar@yahoo.com.
authors.forename: Renato Fortes
authors.initials: RF
authors.lastname: Bittar
authors.affiliation: Hospital do Servidor Público Estadual (IAMSPE), São Paulo, SP, Brazil.
authors.forename: Homero Penha
authors.initials: HP
authors.lastname: Ferraro
authors.affiliation: Hospital do Servidor Público Estadual (IAMSPE), São Paulo, SP, Brazil.
authors.forename: Marcelo Haddad
authors.initials: MH
authors.lastname: Ribas
authors.affiliation: Hospital do Servidor Público Estadual (IAMSPE), São Paulo, SP, Brazil.
authors.forename: Carlos Neutzling
authors.initials: CN
authors.lastname: Lehn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology* / Q000601:surgery; D009333:Neck; D037981:Neck Dissection; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Carcinoma espinocelular; Head and neck neoplasms; Lymph node metastasis; Metástase linfática; Neoplasias de cabeça e pescoço; Neoplasias orais; Oral neoplasms; Prognosis; Prognóstico; Resultados de sobrevida; Squamous cell carcinoma; Survival outcomes