title: Outcome and cervical metastatic spread of squamous cell cancer of the buccal mucosa, a retrospective analysis of the past 25 years.
abstract: OBJECTIVE
  Because of the low proportion of squamous cell carcinomas (SCCs) of the buccal mucosa within the carcinomas of the oral cavity in the Western population, data concerning metastatic pattern are sparse. Therefore, this retrospective study is focusing on the occurrence of cervical metastases (CM) and the overall outcome of this tumor entity.
  
  
  METHODS
  From January 1988 to October 2013, 113 patients were treated in the Department of Oral and Maxillofacial Surgery, Mainz, for an oral SCC of the cheek. Metastatic pattern and clinical parameters that are possibly associated with an increased risk for CM as well as overall outcome were analyzed.
  
  
  RESULTS
  The average follow-up was 48 months (range: 1-248 months). A total of 55 (49%) patients were female and 58 (51%) male, with an average age of 65 ± 13 years (♀68 ± 14 years; ♂63 ± 11 years). In total, 55% of the patients either smoked and/or consumed alcohol. In total, 34% of the patients had a stage III or IV tumor, with overall 23% having CM at the time of diagnosis. During the follow-up, 50% (n = 56) of the patients developed a relapse after 12 months (median). Tumor size (P = 0.002*) and grading (P < 0.001*) are significantly associated with the occurrence of CM. Metastases (P = 0.008*) and advanced tumor size (P = 0.018) had an influence on the survival, whereas the relapse had no significant influence (P = 0.928). Five-year survival rate was 80%.
  
  
  CONCLUSIONS
  SCC of the buccal mucosa shows aggressive behavior with a considerably high proportion of relapse. Since overall outcome is significantly decreased by the cervical metastatic pattern, a selective, ipsilateral neck dissection for this patient group is recommended as the primary management.
authors.affiliation: Department of Oral and Maxillofacial Surgery - Plastic Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Keyvan
authors.initials: K
authors.lastname: Sagheb
authors.affiliation: Department of Oral and Maxillofacial Surgery - Plastic Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Blatt
authors.affiliation: Department of Oral and Maxillofacial Surgery - Plastic Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Ina Sophie
authors.initials: IS
authors.lastname: Kraft
authors.affiliation: Department of Pathology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Zimmer
authors.affiliation: Department of Oral and Maxillofacial Surgery - Plastic Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Roman-Kia
authors.initials: RK
authors.lastname: Rahimi-Nedjat
authors.affiliation: Department of Oral and Maxillofacial Surgery - Plastic Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Bilal
authors.initials: B
authors.lastname: Al-Nawas
authors.affiliation: Department of Oral and Maxillofacial Surgery - Plastic Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Walter
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000556:secondary* / Q000601:surgery; D002610:Cheek; D005260:Female; D006258:Head and Neck Neoplasms / Q000556:secondary* / Q000601:surgery; D006801:Humans; D008297:Male; D009061:Mouth Mucosa / Q000473:pathology*; D009062:Mouth Neoplasms / Q000473:pathology* / Q000601:surgery; D009333:Neck / Q000473:pathology*; D037981:Neck Dissection; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
keywords: head and neck cancer; lymphatic metastasis; oral cancer; squamous cell carcinoma of the buccal mucosa