The strategy on managing cervical lymph nodes of patients with maxillary gingival squamous cell carcinoma

We aimed to determine the risk of occult cervical metastasis of maxillary gingival squamous cell carcinoma (SCC), the predisposing factors for occult cervical metastasis and the therapeutic value of elective neck dissection (END) in survival of clinically negative neck node (cN0) patients.

A retrospective study of patients with maxillary gingival SCC was conducted in our hospital. Clinical information including age, gender, TNM staging, pathological staging, as well as other demographic and clinical data was acquired and analyzed. The Kaplan-Meier method was used to evaluate overall survival rate. Descriptive and bivariate statistics were computed.

The sample was composed of 107 patients (43 men, 64 women). The overall lymph node metastasis (LNM) rate was 28%. The LNM rates were 7.1%, 15%, 41.7% and 44.8% for T1 to T4 stage tumors, and were 9.3%, 46.8%, and 50% for pathological grades I to III. The tumor stage and pathological grade showed a significant relationship with cervical metastasis (P < 0.01). The 5-year survival rate was higher in those who had an END (76%) when compared to those who did not receive an END (46.4%; P < 0.05). With regard to the nodal status, pN0 group had a higher survival rate than pN + group (P < 0.01).

The results of this study suggest that the risk of LNM for SCC originating from the maxillary gingiva is higher than expected and comparable to that for other oral sites. We recommend END for T3 and T4 stage cN0 patients, especially for moderately and poorly-differentiated tumors.