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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (4): 702-707. doi: 10.19723/j.issn.1671-167X.2023.04.022

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Clinical factors affecting the prognosis of lower gingival squamous cell carcinoma

Han LU1,Jian-yun ZHANG2,Rong YANG1,Le XU1,Qing-xiang LI1,Yu-xing GUO1,*(),Chuan-bin GUO1,*()   

  1. 1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
    2. Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
  • Received:2020-09-14 Online:2023-08-18 Published:2023-08-03
  • Contact: Yu-xing GUO,Chuan-bin GUO E-mail:gladiater1984@163.com;guodazuo@sina.com
  • Supported by:
    the National Natural Science Foundation of China(81972540);the National Natural Science Foundation of China(81900979);Peking University Medical Youth Science and Technology Innovation Foundation(BMU2018PY004)

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Abstract:

Objective: To define the clinical factors that influence local recurrence and survival in patients with lower gingival squamous cell carcinoma (LGSCC) and determine whether bone invasion is an independent prognostic factor for them. Methods: A total of 104 patients with LGSCC hospitalized in Peking University Stomatology Hospital from June 2013 to December 2015 were enrolled in this retrospective study.All the patients were followed-up for more than 3 years.The degree of bone invasion was assessed using preoperative imaging data (CT and panoramic radiograph).The degree of bone invasion was divi-ded into four categories: no bone invasion, invasion of cortical bone, invasion of bone marrow cavity, and invasion of the mandibular canal.According to the central position of tumor, it was divided into two types: anterior mandibular invasion (anterior region of the mental foramen) and posterior mandibular invasion (posterior region of the mental foramen). Results: of different invasion depth groups were compared using Mann-Whitney U test.P value < 0.05 was considered to be statistically significant.Kaplan-Meier survival analysis method was used to draw survival curve, and COX regression was used to explore the risk ratio (HR) and 95% confidence interval (CI) of prognostic factors of LGSCC. Results: The follow-up results showed that the 1-, 3-, and 5-year survival rates of LGSCC in this group were 91%, 84%, 82%, respectively.32.7%(34/104) of patients had cervical lymph node metastasis.The cervical lymph node metastasis rate of the anterior segment of the mandible was 12.5%(2/16), and 36.4%(32/88) for the posterior segment of the mandible (P < 0.05).Univariate and multivariate COX analysis showed that the N stage and local recurrence were the prognostic factors of LGSCC patients (P < 0.05). Conclusion: As the degree of mandibular invasion increases, the prognosis of patients with mandibular gum cancer becomes worse.N stage and local recurrence are prognostic risk factors for LGSCC.The incidence of cervical lymph node metastasis for LGSCC is related to the primary tumor location.It is concluded that tumors located at the posterior of the mandible might be more prone to cervical lymph node metastasis than the anterior of the mandible.Thus various levels of cervical lymph node dissection strategies should be adopted for different sites of LGSCC.

Key words: Gingival neoplasms, Squamous cell carcinoma, Mandible, Neoplasm invasiveness, Prognosis

CLC Number: 

  • R739.8

Table 1

Clinicopathological characteristics of patients with lower gingival squamous cell carcinoma"

Characteristics n (%)
Gender
  Male 57 (54.8)
  Female 47 (45.2)
Age
   < 65 years 66 (63.5)
  ≥65 years 38 (36.5)
T stage
  T1 17 (16.3)
  T2 30 (28.8)
  T3 4 (3.8)
  T4 53 (51.0)
N stage
  N0 70 (67.3)
  N1 16 (15.4)
  N2 18 (17.3)
M stage
  M0 104 (100.0)
  M1 0
Pathology
  Ⅰ 48 (46.2)
  Ⅱ 51 (49.0)
  Ⅲ 5 (4.8)
Localization
  Anterior 16 (15.4)
  Posterior 88 (84.6)
Bone invasion
  Absent 18 (17.3)
  Cortical 33 (31.7)
  Medullary 33 (31.7)
  Mandibular canal 20 (19.2)
Recurrence
  No 70 (67.3)
  Yes 34 (32.7)

Figure 1

Survival curves of lower gingival squamous cell carcinoma with different depth of the jaw bone invasion"

Figure 2

Influence of distance from surgical margin to tumor boundary on local recurrence of lower gingival squamous cell carcinoma A, all lower gingival squamous cell carcinoma; B, segmental osteotomy; C, marginal osteotomy."

Table 2

The relationship between the primary location, invasion depth of lower gingival squamous cell carcinoma and cervical lymph node metastasis"

ItemsAnteriorP
Absent Cortical Medullary Mandibular canal
N0 4 6 3 1 0.019
N+ 0 0 0 2
ItemsPosteriorP
Absent Cortical Medullary Mandibular canal
N0 9 18 20 9 0.785
N+ 5 9 10 8

Table 3

The univariate Cox regression analysis of lower gingival squamous cell carcinoma"

VariableOverall survival Disease-specific survival
HR (95%CI) P HR (95%CI) P
Age (≥65 vs. < 65 years) 1.65 (0.67-4.07) 0.275 2.06 (0.79-5.33) 0.138
Gender (Female vs. Male) 0.40 (0.14-1.10) 0.076 0.46 (0.16-1.31) 0.148
Tumor differentiation 0.130 0.096
  Moderate vs. Well 2.39 (0.84-6.79) 0.102 2.74 (0.87-8.60) 0.084
  Poor vs. Well 2.39 (0.84-6.80) 0.073 5.62 (1.03-30.76) 0.046
T stage 0.827 0.536
  T2 vs. T1 0.74 (0.17-3.29) 0.688 2.21 (0.25-19.80) 0.478
  T3 vs. T1 1.56 (0.16-15.02) 0.700 4.63 (0.29-74.12) 0.278
  T4 vs. T1 1.21 (0.34-4.35) 0.766 3.65 (0.47-28.25) 0.216
N stage 0.004 0.002
  N1 vs. N0 2.81 (0.82-9.59) 0.100 2.45 (0.61-9.81) 0.205
  N2 vs. N0 5.64 (2.04-15.57) 0.001 6.54 (2.27-18.88) 0.001
Bone invasion 0.410 0.249
  Cortical vs. Absent 1.77 (0.36-8.77) 0.485 2.93 (0.34-25.10) 0.326
  Medullary vs. Absent 1.43 (0.28-7.36) 0.671 2.84 (0.33-24.31) 0.341
  Canal vs. Absent 3.20 (0.65-15.85) 0.155 6.40 (0.77-53.24) 0.086
Osteotomy (Marginal vs. Segmental) 1.92 (0.69-5.33) 0.211 1.65 (0.58-4.68) 0.349
Location (Anterior vs. Posterior) 0.49 (0.17-1.33) 0.157 0.55 (0.18-1.69) 0.297
Recurrence 6.98 (2.51-19.41) < 0.001 11.55 (3.31-40.24) < 0.001

Table 4

The multivariate Cox regression analysis of lower gingival squamous cell carcinoma"

VariableOverall survival Disease-specific survival
HR (95%CI) P HR (95%CI) P
N stage < 0.001 < 0.001
  N1 vs. N0 3.52 (1.02-12.08) 0.046 3.20 (0.80-12.87) 0.101
  N2 vs. N0 8.01 (2.82-22.73) < 0.001 9.99 (3.34-29.86) < 0.001
Recurrence 9.12 (3.22-25.82) < 0.001 15.65 (4.40-55.70) < 0.001
1 Montero PH , Patel SG . Cancer of the oral cavity[J]. Surg Oncol Clin N Am, 2015, 24 (3): 491- 508.
doi: 10.1016/j.soc.2015.03.006
2 Fives C , Nae A , Roche P , et al. Impact of mandibular invasion on prognosis in oral squamous cell carcinoma four centimeters or less in size[J]. Laryngoscope, 2017, 127 (4): 849- 854.
doi: 10.1002/lary.26211
3 Fried D , Mullins B , Weissler M , et al. Prognostic significance of bone invasion for oral cavity squamous cell carcinoma considered T1/T2 by American joint committee on cancer size criteria[J]. Head Neck, 2014, 36 (6): 776- 781.
doi: 10.1002/hed.23367
4 万艳, 尚政军. 牙龈癌的流行病学危险因素研究[J]. 临床口腔医学杂志, 2013, 29 (7): 402- 404.
5 Yoshida S , Shimo T , Murase Y , et al. The prognostic implications of bone invasion in gingival squamous cell carcinoma[J]. Anticancer Res, 2018, 38 (2): 955- 962.
6 Ebrahimi A , Murali R , Gao K , et al. The prognostic and staging implications of bone invasion in oral squamous cell carcinoma[J]. Cancer, 2011, 117 (19): 4460- 4467.
doi: 10.1002/cncr.26032
7 Lee KC , Chuang SK , Philipone EM , et al. Which clinicopathologic factors affect the prognosis of gingival squamous cell carcinoma: A population analysis of 4 345 cases[J]. J Oral Maxillofac Surg, 2019, 77 (5): 986- 993.
doi: 10.1016/j.joms.2019.01.007
8 Okura M , Yanamoto S , Umeda M , et al. Prognostic and staging implications of mandibular canal invasion in lower gingival squamous cell carcinoma[J]. Cancer Med, 2016, 5 (12): 3378- 3385.
doi: 10.1002/cam4.899
9 Brierley J , Gospodarowicz MK , Wittekind C . TNM classification of malignant tumours[M]. 8ed Chichester, West Sussex, UK & Hoboken, NJ: John Wiley & Sons, Inc, 2017.
10 Smits RWH , Ten Hove I , Dronkers EAC , et al. Evaluation of bone resection margins of segmental mandibulectomy for oral squamous cell carcinoma[J]. Int J Oral Maxillofac Surg, 2018, 47 (8): 959- 964.
doi: 10.1016/j.ijom.2018.03.006
11 Ahmad JG , Namin AW , Jorgensen JB , et al. Mandibular invasion by oral squamous cell carcinoma: Clinicopathologic features of 74 cases[J]. Otolaryngol Head Neck Surg, 2019, 160 (6): 1034- 1041.
doi: 10.1177/0194599818821859
12 Singh A , Mair M , Singhvi H , et al. Incidence, predictors and impact of positive bony margins in surgically treated T4 stage cancers of the oral cavity[J]. Oral Oncol, 2019, 90 (3): 8- 12.
13 Cariati P , Serrano AC , Solis JF , et al. Intraoperative cytological examination of bone medullary. A useful technique to predict the extension of bone invasion in segmental mandibulectomy[J]. Am J Otolaryngol, 2019, 40 (5): 743- 746.
doi: 10.1016/j.amjoto.2019.07.005
14 Haase C , Lethaus B , Knuchel-Clarke R , et al. Development of a rapid analysis method for bone resection margins for oral squamous cell carcinoma by immunoblotting[J]. Head Neck Pathol, 2018, 12 (2): 210- 220.
doi: 10.1007/s12105-017-0856-4
15 Niu LX , Feng ZE , Wang DC , et al. Prognostic factors in mandi-bular gingival squamous cell carcinoma: A 10-year retrospective study[J]. Int J Oral Maxillofac Surg, 2017, 46 (2): 137- 143.
doi: 10.1016/j.ijom.2016.09.014
16 Nieberler M , Haussler P , Kesting MR , et al. Intraoperative cell isolation for a cytological assessment of bone resection margins in patients with head and neck cancer[J]. Br J Oral Maxillofac Surg, 2017, 55 (5): 510- 516.
doi: 10.1016/j.bjoms.2017.02.006
17 Nieberler M , Haussler P , Kesting MR , et al. Clinical impact of intraoperative cytological assessment of bone resection margins in patients with head and neck carcinoma[J]. Ann Surg Oncol, 2016, 23 (11): 3579- 3586.
doi: 10.1245/s10434-016-5208-1
18 Gou L , Yang W , Qiao X , et al. Marginal or segmental mandibulectomy: treatment modality selection for oral cancer: A systematic review and meta-analysis[J]. Int J Oral Maxillofac Surg, 2018, 47 (1): 1- 10.
doi: 10.1016/j.ijom.2017.07.019
19 Namin AW , Bollig CA , Harding BC , et al. Implications of tumor size, subsite, and adjuvant therapy on outcomes in pT4aN0 oral cavity carcinoma[J]. Otolaryngol Head Neck surg, 2020, 162 (5): 683- 692.
doi: 10.1177/0194599820904679
20 李传真, 郭传瑸. 口腔颌面部鳞癌原发灶部位对颈淋巴结转移区域的影响[J]. 北京大学学报(医学版), 2014, 46 (3): 469- 473.
21 Brockhoff HC , Kim RY , Braun TM , et al. Correlating the depth of invasion at specific anatomic locations with the risk for regional metastatic disease to lymph nodes in the neck for oral squamous cell carcinoma[J]. Head Neck, 2017, 39 (5): 974- 979.
doi: 10.1002/hed.24724
22 Wang Y , Li Q , Xu L , et al. Cancer stemness of CD10-positive cells regulated by Hedgehog pathway promotes the resistance to cisplatin in oral squamous cell carcinoma[J]. Oral Dis, 2021, 27 (6): 1403- 1411.
doi: 10.1111/odi.13673
23 Li Q , Wang Y , Xu L , et al. High level of CD10 expression is associated with poor overall survival in patients with head and neck cancer[J]. Int J Oral Maxillofac Surg, 2021, 50 (7): 857- 864.
doi: 10.1016/j.ijom.2020.07.037
24 Nassiri AM , Campbell BR , Mannion K , et al. Survival outcomes in T4aN0M0 mandibular gingival squamous cell carcinoma treated with surgery alone[J]. Otolaryngol Head Neck Surg, 2019, 160 (5): 870- 875.
doi: 10.1177/0194599818821892
25 Hasegawa T , Yanamoto S , Otsuru M , et al. Multi-center retrospective study of the prognosis and treatment outcomes of Japanese oral squamous cell carcinoma patients with single lymph node metastasis and extra nodal extension[J]. J Surg Oncol, 2018, 117 (8): 1736- 1743.
doi: 10.1002/jso.25083
26 Lubek J , El-Hakim M , Salama AR , et al. Gingival carcinoma: Retrospective analysis of 72 patients and indications for elective neck dissection[J]. Br J Oral Maxillofac Surg, 2011, 49 (3): 182- 185.
doi: 10.1016/j.bjoms.2010.04.005
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