Outcome and cervical metastatic spread of squamous cell cancer of the buccal mucosa, a retrospective analysis of the past 25 years

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Oral cancer is the sixth most common cancer with an annual incidence of approximately 300 000 1. Besides its wide geographic variation, the incidence of oral cancer continues to rise not only in the countries with the highest burden (South and South‐East Asia) but also in the West 2. Although there is a significant increase in the 5‐year relative survival rates for the Western countries in the past 4 decades, the overall survival is still about 66% 4 and for the developing countries still low about 40% 3. Both the tumor size and the presence of cervical metastasis (CM) at the time of initial diagnosis are the most important clinical prognostic factors 5. The treatment of choice of oral SCC is the surgical resection with adequate safety margins in combination with neck dissection by clinical positive neck 7. But the therapeutic approach for the clinical negative neck (cN0) still remains controversial because of occult lymph node metastases especially in small tumors 8. In these cases, histopathological features may help to adjust the estimated risk of CM 10.
A recent publication by D'Cruz et al. confirmed that elective neck dissection in cN0 leads to a significantly enhanced survival in oral cancer. However, since the large majority of patients (85.3%) showed tongue cancers, results are most applicable to this primary site 12.
Factual data for the clinical behavior and metastasis of squamous cell carcinomas (SCCs) of the buccal mucosa have been published for the Asian population with its typical risk factor betel nuts/tobacco chewing 13. But due to the low proportion of squamous cell carcinomas (SCCs) of the buccal mucosa within the carcinomas of the oral cavity in the Western population, there are only few studies about this entity 14. Due to this etiological heterogeneity, metastatic pattern in the Asian population is more adequately described, predominately with a low rate for CM 13. Furthermore, treatment protocols differ; for example, elective neck dissection for stage I and II is not routinely performed that can significantly influence clinical outcome in terms of survival rate 18. Not much is known about the outcome and metastatic behavior of this tumor localization for the Western population 14. The objective of this study was to evaluate the clinical data and analyze the histopathological features that may influence the risk for CM and the outcome.
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