Extracapsular spread in oral squamous cell carcinoma.

Area of Science:

• Oncology
• Head and Neck Surgery
• Pathology

Background:

• Extracapsular spread (ECS) in cervical lymph nodes is a major negative prognostic factor for oral squamous cell carcinoma (OSCC).
• Accurate identification of ECS is critical for effective treatment planning and patient counseling.

Purpose of the Study:

• To evaluate the prognostic significance of ECS in OSCC.
• To assess the impact of ECS on recurrence, metastasis, and survival.
• To identify predictors of ECS and evaluate imaging sensitivity.

Main Methods:

• Analysis of a consecutive cohort of 400 OSCC patients treated with primary surgery.
• Assessment of ECS presence, macroscopic vs. microscopic, and its correlation with clinical outcomes.
• Evaluation of MRI neck staging sensitivity and identification of independent predictors for ECS.

Main Results:

• ECS was present in 25% of patients, significantly increasing local recurrence, distant metastases, and regional failure.
• Recurrences were earlier in ECS cases (206 vs. 334 days).
• Five-year overall survival was 19% for macroscopic ECS versus 31% for microscopic ECS; MRI showed poor sensitivity, especially for microscopic ECS. Age >75, smoking, and alcohol use predicted ECS.

Conclusions:

• ECS is a critical prognostic indicator in OSCC, necessitating its reporting for accurate staging.
• Patients with OSCC and ECS should be classified as pN3 due to their poor prognosis.
• Factors like age, smoking, and alcohol may influence immunosurveillance, contributing to ECS development.