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Head and Neck Surgery

(0611) Association of Lymph Node Yield and Involvement With Depth of Invasion in Oral Cancers

Monday, September 30, 2024
12:00 PM – 1:00 PM EDT
Disclosure(s):
Alexandra T. Bourdillon, MD: No relevant relationships to disclose.
Andrew Nazarenko, MS: No relevant relationships to disclose.
Hudson Lin: No relevant relationships to disclose.
Zainab Farzal, MD: No relevant relationships to disclose.
Mary Jue Xu, MD: No relevant relationships to disclose.
Katherine Wai, MD: No relevant relationships to disclose.
Jonathan George, MD, MPH: No relevant relationships to disclose.
Ivan H. El-Sayed, MD: No relevant relationships to disclose.
Patrick Ha, MD: No relevant relationships to disclose.
Chase Heaton, MD: No relevant relationships to disclose.


Introduction: The 8th edition of the AJCC staging saw the inclusion of depth of invasion (DOI) as a significant prognosticator of nodal metastasis and oncologic outcomes. Given the recency of determining and integrating this pathologic feature, its relationship with other pathologic variables such as lymph node yield warrants further investigation, especially among some subsites.

Methods: We investigated the relationship of 300 patients with OCCs identified from our tumor registry who underwent surgical resection and neck dissection and had pathologically determined DOI and relationship with lymph node involvement, yield, and positivity ratio.

Results: Our cohort predominantly involved tumors of the oral tongue (55%), followed by alveolar ridge and gingiva (30%), and other sites (14%). The greatest proportion were classified as T4 (46%), followed by T3 (30%), T2 (13%), and T1 (11%). Of the total, 52% were pN0, while 11%, 17%, and 20% were pN1, pN2, and pN3, respectively. The majority had negative surgical margins (63%). Univariate analysis showed that DOI significantly correlated with nodal metastasis (p = 0.04), number of lymph nodes removed (p < 0.01) but not number of positive nodes (p = 0.5) or lymph node ratio (p = 0.61). Multivariate regression showed nodal metastasis significantly improved model accuracy with DOI (p = 0.04) in addition to age (p = 0.02) and T Category (p < 0.01), even after controlling for margin status, tobacco history, and alcohol history. Similar results were obtained when controlling for margin distance instead of status, yielding that DOI (p = 0.0004), age (p = 0.0015) and T category (p < 0.0001) were significantly associated with nodal involvement.

Conclusions: Our preliminary study shows that DOI as a continuous variable is significantly associated with certain clinicopathologic features including age, T-stage, and number of examined lymph nodes. Further studies are needed to evaluate if DOI is prognostic of lymph node involvement and other pathologic features.

    Presenting Author(s)

  • Alexandra T. Bourdillon, MD

    Resident Physician
    University of California, San Francisco
    San Francisco, California, United States

    • Co-Author(s)

  • HA

    Hasan Abdulbaki

    University of California, San Francisco, California, United States

  • Andrew Nazarenko, MS

    Medical Student
    New York Medical College
    Cupertino, California, United States

  • Hudson Lin

    Medical Student
    University of California, San Francisco
    SAN FRANCISCO, California, United States

  • ZF

    Zainab Farzal, MD

    Assistant Professor
    UT-Southwestern Medical Center
    Frisco, Texas, United States

  • Mary Jue Xu, MD

    Assistant Professor
    University of California, San Francisco
    San Francisco, California, United States

  • KW

    Katherine Wai, MD

    Assistant Professor
    University of California, San Francisco
    San Francisco , California, United States

  • William R. Ryan, MD

    Associate Professor of Otolaryngology- Head & Neck Surgery
    University of California, San Francisco
    San Francisco, California, United States

  • JG

    Jonathan George, MD, MPH

    Associate Professor
    University of California, San Francisco
    San Francisco, California, United States

  • IE

    Ivan H. El-Sayed, MD

    Professor
    UCSF
    San Francisco, California, United States

    • Senior Author(s)

  • Patrick Ha, MD

    Professor
    University of California, San Francisco
    San Francisco, California, United States

  • Chase Heaton, MD

    Associate Professor
    University of California, San Francisco
    San Francisco, California, United States