Perineural Invasion and Lymph Node Ratio Quartile are Associated with Extranodal Extension in Oral Cavity Squamous Cell Carcinoma

Piper A. Wenzel; Steven L. Van Meeteren; Nitin A. Pagedar; Marisa R. Buchakjian

doi:10.1016/j.joms.2025.02.012

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Perineural Invasion and Lymph Node Ratio Quartile are Associated with Extranodal Extension in Oral Cavity Squamous Cell Carcinoma

Journal article

Peer reviewed

Perineural Invasion and Lymph Node Ratio Quartile are Associated with Extranodal Extension in Oral Cavity Squamous Cell Carcinoma

Piper A. Wenzel, Steven L. Van Meeteren, Nitin A. Pagedar and Marisa R. Buchakjian

Journal of oral and maxillofacial surgery, Vol.83(6), pp.768-775

06/2025

DOI: 10.1016/j.joms.2025.02.012

PMID: 40120633

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Abstract

In contrast to extranodal extension (ENE), tumor characteristics can often be evaluated preoperatively in patients with oral cavity squamous cell carcinoma (OCSCC). If correlations exist between primary tumor characteristics and the presence of ENE, evaluating these factors could help provide more accurate patient counseling and adjuvant treatment planning before undergoing surgical therapy. The study purpose was to identify associations between OCSCC pathologic characteristics and ENE. We performed a retrospective cohort study of adult patients who underwent upfront curative-intent surgery for OCSCC at the University of Iowa Hospitals and Clinics from 2004-2018. The treating service was otolaryngology-head and neck surgery. Exclusion criteria included patients who did not undergo neck dissection, primary tumor occurring outside the oral cavity, pathologic N0, cancer previously treated with radiation or surgically at another institution, and gross disease remaining after surgery. The predictor variable was a set of tumor characteristics including oral cavity subsite, T- and N- classification, perineural invasion (PNI), lymphovascular invasion, bone invasion, and positive lymph node ratio (LNR). The main outcome variable was ENE status, defined as positive (at least one lymph node reported to have ENE) or negative, identified from pathology reports. Covariates included subject sex, age, and smoking history. Bivariate comparisons and multivariate logistic regression analyses were performed to identify correlations between predictor variables/covariates and presence of ENE. Statistical significance was set at p=0.05. The sample was composed of 233 subjects with a mean age of 60.5 (SD 12.5), and 154 (66.1%) were male. Of 233 subjects with nodal metastasis, 122 (52.4%) had ENE in at least one node, and the median (interquartile range) positive LNR was 0.083 (0.094). On bivariate analysis, PNI (RR 1.49, 95% CI [1.14-1.96], p=0.002), bone invasion (RR 1.42, 95% CI [1.13-1.80], p=0.005), LNR quartile (p<0.001), and pathologic T-class (8th edition) (p=0.001) were significantly correlated with ENE. On multivariate logistic regression analysis, PNI (OR 2.29, 95% CI [1.21-4.31], p=0.01) and LNR quartile (p<0.001) remained significantly correlated with ENE. This study offers insight into important clinicopathologic details of lymph node metastases in OCSCC with an emphasis on tumor characteristics and odds of ENE in one or more lymph nodes. This information may be beneficial for patient counseling and treatment planning, especially in patients with PNI and high positive LNR but no evidence of obvious ENE prior to surgery.

extracapsular spread

extranodal extension

lymph node metastasis

lymph node ratio

oral cavity squamous cell carcinoma

Details

Title: Subtitle: Perineural Invasion and Lymph Node Ratio Quartile are Associated with Extranodal Extension in Oral Cavity Squamous Cell Carcinoma
Creators: Piper A. Wenzel - University of Iowa
Steven L. Van Meeteren - University of Iowa
Nitin A. Pagedar - University of Iowa
Marisa R. Buchakjian - University of Iowa
Resource Type: Journal article
Publication Details: Journal of oral and maxillofacial surgery, Vol.83(6), pp.768-775
DOI: 10.1016/j.joms.2025.02.012
PMID: 40120633
NLM abbreviation: J Oral Maxillofac Surg
ISSN: 0278-2391
eISSN: 1531-5053
Publisher: Elsevier Inc
Grant note: National Institutes of Health (NIH) National Cancer Institute: P30CA086862 National Center for Advancing Translational Sciences: UM1TR004403
This work was supported by use of resources from the National Institutes of Health (NIH) National Cancer Institute (grant No. P30CA086862) and National Center for Advancing Translational Sciences (grant No. UM1TR004403) . The authors would like acknowledge the Holden Comprehensive Cancer Center Oncology Registry.
Language: English
Electronic publication date: 03/2025
Date published: 06/2025
Academic Unit: The University of Iowa Institute for Vision Research; Otolaryngology
Record Identifier: 9984800194102771

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