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Updated: May 13, 2026
Modified Radical Neck Dissection for Cervical Metastasis
Published on: February 20, 2026
Treatment strategy for cervical lymph node metastases in patients with lower gingival carcinoma undergoing mandibular
Masaru Ogawa1, Satoshi Yokoo2, Takahiro Yamaguchi2
1Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, 3-39-15, Showa-machi, Maebashi-city, Gunma, 371-8511, Japan. masaru0523@gunma-u.ac.jp.
Objectives:
This study aimed to investigate the incidence, prognostic impact, and preoperative predictive factors of cervical lymph node metastasis (CLM) in patients with clinically node-negative (cN0) lower gingival squamous cell carcinoma (SCC) treated with marginal mandibulectomy, with particular focus on biopsy-based pathological parameters.
Materials And Methods:
Forty-two patients with cN0 lower gingival SCC who underwent marginal mandibulectomy as initial treatment were retrospectively analysed. Clinical findings and histopathological features assessed using biopsy specimens included tumour differentiation grade, Yamamoto-Kohama mode of invasion, tumour budding (TB), mitotic count, and buccal mucosal invasion. Associations with CLM and survival outcomes were statistically evaluated. Multivariate logistic regression analysis was performed to identify independent predictors of CLM.
Results:
CLM occurred in 12 of 42 cases (28.6%), including late CLM in six cases. Multivariate analysis identified a budding score (BS) ≥ 5 and buccal mucosal invasion as independent predictors of CLM. Patients with CLM showed significantly poorer 5-year disease-specific survival (5y-DSS) than those without CLM (59.4% vs. 100%, P = 0.003). BS ≥ 5 was also significantly associated with worse 5y-DSS (P = 0.012). A combined model incorporating BS ≥ 5 and buccal mucosal invasion (BB model) demonstrated high specificity for predicting CLM.
Conclusions:
Even in patients with early-stage lower gingival SCC eligible for marginal mandibulectomy without bone marrow invasion, CLM occurs at a considerable frequency and significantly affects prognosis. Preoperative risk stratification using biopsy-based BS and buccal mucosal invasion may facilitate selective application of elective neck dissection and contribute to improved oncological outcomes.
Clinical Relevance:
TB and buccal mucosal invasion assessed in biopsy specimens are useful preoperative predictors of CLM in early-stage lower gingival SCC and may aid in optimising neck management strategies.