title: Association of Lymphovascular Space Invasion With Locoregional Failure and Survival in Patients With Node-Negative Oral Tongue Cancers.
abstract: The indications for adjuvant therapy in resected oral tongue cancers are based on both clinical and pathological factors, with clear evidence for adjuvant radiation in patients with pathologically positive neck lymph nodes, positive margins, and extracapsular extension, but the data for patients with no nodal disease are sparse.
  
  
  
  To investigate determinants of failure and survival in patients with node-negative oral tongue cancer.
  
  
  
  Medical records for patients with oral tongue cancer treated with definitive surgery from 2003 to 2013 were reviewed. All patients were cN0 negative and classified as pathologically node-negative (pN0) if a neck dissection was performed. Patients received adjuvant radiotherapy (RT) or chemoradiotherapy (CRT) based on standard clinical and pathological determinants.
  
  
  
  Kaplan-Meier and multivariable (MVA) logistic regression and Cox proportional hazard regression analyses were performed to identify patient, tumor, and treatment characteristics predictive of locoregional control (LRC) and overall survival (OS).
  
  
  
  A total of 180 patients met entry criteria, with a median follow-up time of 4.9 years (range, 0.9-12.5 years); 102 patients (56.7%) were female and 42 patients (23.3%) were younger than 45 years at diagnosis. One hundred fifty-three patients (85%) had T1/T2 tumors, and 112 patients (62%) had elective neck dissections with confirmed pN0. Lymphovascular space invasion (LVSI) was present in 36 patients (20%). On MVA, LVSI (OR, 0.06; 95% CI, 0.02-0.19; P < .01) was associated with worse LRC. Elective neck dissection (odds ratio [OR], 2.99; 95% CI, 1.16-7.73; P = .02) and receipt of RT (OR, 7.74; 95% CI, 2.27-26.42; P < .01) were associated with improved LRC. Three-year LRC rates were significantly lower for patients with LVSI (38.8%; 95% CI, 22.8%, 54.6%) than those without LVSI (81.9%; 95% CI, 74.4%, 87.4%). On MVA, only LVSI (hazard ratio, 2.20; 95% CI, 1.19-4.06; P = .01) and age greater than 44 years (hazard ratio, 4.38; 95% CI, 1.34-14.27; P = .01) were associated with worse OS. Three-year OS rates were significantly lower in patients with LVSI (71.3%; 95% CI, 53.2%-83.4%) than those without LVSI (90.3%; 95% CI, 83.8%-94.3%).
  
  
  
  Lymphovascular space invasion in patients with node-negative oral tongue cancer treated with upfront definitive surgery is associated with worse LRC and OS. Node-negative oral cavity cancers with LVSI warrant consideration of further adjuvant therapy, which should be further evaluated in a prospective setting.
authors.affiliation: Department of Radiation Oncology, Emory University, Atlanta, Georgia2Winship Cancer Institute at Emory University, Atlanta, Georgia.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Cassidy
authors.affiliation: Winship Cancer Institute at Emory University, Atlanta, Georgia3Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Switchenko
authors.affiliation: Department of Radiation Oncology, Emory University, Atlanta, Georgia2Winship Cancer Institute at Emory University, Atlanta, Georgia.
authors.forename: Naresh
authors.initials: N
authors.lastname: Jegadeesh
authors.affiliation: University of Vermont, College of Medicine, Burlington5Department of Otolaryngology, Emory University, Atlanta, Georgia.
authors.forename: Mutlay
authors.initials: M
authors.lastname: Sayan
authors.affiliation: Department of Radiation Oncology, Emory University, Atlanta, Georgia2Winship Cancer Institute at Emory University, Atlanta, Georgia.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Ferris
authors.affiliation: Department of Radiation Oncology, Emory University, Atlanta, Georgia2Winship Cancer Institute at Emory University, Atlanta, Georgia.
authors.forename: Bree R
authors.initials: BR
authors.lastname: Eaton
authors.affiliation: Department of Radiation Oncology, Emory University, Atlanta, Georgia2Winship Cancer Institute at Emory University, Atlanta, Georgia.
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Higgins
authors.affiliation: Winship Cancer Institute at Emory University, Atlanta, Georgia5Department of Otolaryngology, Emory University, Atlanta, Georgia.
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Wadsworth
authors.affiliation: Winship Cancer Institute at Emory University, Atlanta, Georgia6Department of Pathology, Atlanta, Emory University, Georgia.
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Magliocca
authors.affiliation: Winship Cancer Institute at Emory University, Atlanta, Georgia7Department of Medical Oncology, Emory University, Atlanta, Georgia.
authors.forename: Nabil F
authors.initials: NF
authors.lastname: Saba
authors.affiliation: Department of Radiation Oncology, Emory University, Atlanta, Georgia2Winship Cancer Institute at Emory University, Atlanta, Georgia5Department of Otolaryngology, Emory University, Atlanta, Georgia7Department of Medical Oncology, Emory University, Atlanta, Georgia.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Beitler
mesh_terms: D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy; D005260:Female; D005927:Glossectomy; D006801:Humans; D016015:Logistic Models; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate; D014062:Tongue Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*