Level V Metastases in Node-Positive Oral Squamous Cell Carcinoma: Beyond Level IIA and III

Area of Science:

• Oncology
• Head and Neck Surgery

Background:

• The surgical management of level V lymph nodes in clinically node-positive (cN+) oral squamous cell carcinomas (OSCC) remains a subject of debate.
• Identifying predictors for level V metastases is crucial for optimizing treatment strategies in cN+ OSCC.

Purpose of the Study:

• To identify clinical and pathological predictors of level V metastases in patients with cN+ OSCC.

Main Methods:

• A retrospective analysis of institutional data from operated cN+ OSCC cases between April 2018 and December 2022.
• Univariate and multivariate analyses were performed on clinical and pathological parameters to identify significant predictors.
• A p-value < 0.05 was considered statistically significant.

Main Results:

• No level V metastases were observed in patients with cN1 or pN1 disease, and no skip metastases to level V occurred.
• Significant predictors for level V metastases included the total number of positive lymph nodes, lymph node ratio (LNR), extranodal extension (ENE), pN classification, and the presence of metastases in levels II and III.
• Post hoc analysis identified ≥5 positive nodes, LNR > 0.1, and pN3 status as independent risk factors for level V metastases.

Conclusions:

• Selective neck dissection is feasible for N1 OSCC, especially when nodal metastases are confined to level I.
• Comprehensive neck dissection is recommended for patients with bulky nodal disease, including N3 status, ≥5 positive nodes, ENE, and metastases in levels II and III.