title: Prognosis of oral squamous cell carcinoma patients with level IV/V metastasis: An observational study.
abstract: OBJECTIVE
  The objectives of this study were to retrospectively describe the characteristics and outcomes of patients with oral squamous cell carcinoma (OSCC) with level IV/V metastases, and to evaluate the multivariate relationships among potential risk factors for metastasis and prognosis.
  
  
  METHODS
  We evaluated 291 patients (178 men and 113 women; mean age, 65.9 ± 13.5 years). Clinicopathological data, time of development of level IV/V metastases, and clinical course were investigated.
  
  
  RESULTS
  Twenty-three patients (7.9%) developed level IV/V metastases. The 3-year overall survival rates when level IV/V metastasis first developed were 27.3% upon initial treatment, 57.1% when metachronous neck metastasis developed, and 40.0% when the tumor recurred. Oral tongue tumor subsite, high N staging, neck dissection when metachronous neck metastasis developed, as well as recurrence were independent risk factors for level IV/V metastasis.
  
  
  CONCLUSIONS
  We demonstrate here the multivariate relationships among the risk factors indicated above for level IV/V metastasis and their prognostic significance for patients with OSCC. Oral tongue tumors, high N staging, and neck dissection upon the occurrence of metachronous neck metastasis or recurrence were risk factors for level IV/V metastasis and positive extracapsular spread, presence of multiple lymph metastases, and moderate or poor differentiation were poor prognostic factors.
authors.affiliation: Department of Oral and Maxillofacial Surgery (Chief: Prof. T. Komori), Kobe University Graduate School of Medicine, Japan. Electronic address: hasetaku@med.kobe-u.ac.jp.
authors.forename: Takumi
authors.initials: T
authors.lastname: Hasegawa
authors.affiliation: Department of Oral Maxillofacial Surgery (Chief: Prof. Y. Shibuya), Nagoya City University Graduate School of Medical Science, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Shibuya
authors.affiliation: Department of Oral and Maxillofacial Surgery (Chief: Prof. T. Komori), Kobe University Graduate School of Medicine, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Takeda
authors.affiliation: Department of Oral and Maxillofacial Surgery (Chief: Prof. T. Komori), Kobe University Graduate School of Medicine, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Iwata
authors.affiliation: Department of Oral and Maxillofacial Surgery (Chief: Prof. T. Komori), Kobe University Graduate School of Medicine, Japan.
authors.forename: Izumi
authors.initials: I
authors.lastname: Saito
authors.affiliation: Department of Oral and Maxillofacial Surgery (Chief: Prof. T. Komori), Kobe University Graduate School of Medicine, Japan.
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Kakei
authors.affiliation: Department of Oral and Maxillofacial Surgery (Chief: Prof. T. Komori), Kobe University Graduate School of Medicine, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Sakakibara
authors.affiliation: Department of Oral and Maxillofacial Surgery (Chief: Prof. T. Komori), Kobe University Graduate School of Medicine, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Akashi
authors.affiliation: Department of Oral and Maxillofacial Surgery (Chief: Prof. T. Komori), Kobe University Graduate School of Medicine, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Minamikawa
authors.affiliation: Department of Oral and Maxillofacial Surgery (Chief: Prof. T. Komori), Kobe University Graduate School of Medicine, Japan.
authors.forename: Takahide
authors.initials: T
authors.lastname: Komori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000175:diagnosis* / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult
keywords: Lymph node metastasis; Neck level; Oral cancer; Risk factor