Factors Influencing Mandibular Invasion, Lymph Node Metastasis and Extracapsular Spread in Squamous Cell Carcinoma of the Oral Cavity
Abstract
1. Introduction
2. Patients and Methods
2.1. Study Design and Setting
2.2. Participants
2.3. Evaluation and Outcome
2.4. Statistical Analysis
3. Results
4. Discussion
4.1. Interpretation
- Subcapsular Sinus Invasion: Tumor cells initially proliferate in the subcapsular sinus, progressively replacing the nodal architecture. Extracapsular spread (ECS) arises either through direct capsular penetration or via tumor emboli trapped in adjacent capsular and juxtacapsular lymphatics.
- Lymphatic Sinus Infiltration: Widespread tumor infiltration of the lymphatic sinuses occurs while sparing germinal centers and trabeculae. ECS may develop through mechanisms similar to those described above.
- Concurrent Intra- and Extranodal Proliferation: Tumor cells exhibit simultaneous and proportional growth both inside the lymph node and in surrounding tissues.
- Extranodal Embolic Growth: Tumor emboli proliferate without significant intranodal involvement, potentially leading to early ECS in the disease course.
4.2. Limitations
- Prior radiotherapy and secondary tumors exhibit different POI, which was not taken into consideration in our study.
- Several other factors like comorbidities, lifestyle, and patient physical status might impact survival. Further studies are necessary to evaluate the combined effects of each of these factors on survival.
- In our study, the pattern of invasion was determined histologically. Various imaging modalities have been shown to determine the pattern of invasion, comparison of which was not performed in our study.
- Smaller sample size and retrospective nature of the study.
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | Frequency | ||
---|---|---|---|
No. of Patients | Percentage | ||
Mean Age M:F ratio | 54.78 ± 6.4 years 1:0.18 | ||
Site of primary tumor | Buccal mucosa | 40 | 24.70% |
Tongue | 33 | 20.40% | |
Floor of mouth | 35 | 21.60% | |
Mandibular alveolus | 32 | 19.80% | |
Retro molar trigone | 22 | 13.60% | |
pT stage: | T2 | 12 | 7.4% |
T3 | 63 | 38.90% | |
T4a | 76 | 46.90% | |
T4b | 11 | 6.8% | |
pN stage: | N0 | 94 | 58.02% |
N+ | 68 | 42% | |
Mandibular Invasion: Histopathology | No involvement | 76 | 46.9% |
Cortical involvement | 19 | 11.73% | |
Medullary involvement | 67 | 41.40% | |
Erosive | 30 | 34.88% | |
Infiltrative | 56 | 65.11% | |
Grading. | Well | 72 | 44.40% |
Moderate | 47 | 29.0% | |
Poor | 43 | 26.5% | |
LVI | Absent | 101 | 62.3% |
Present | 61 | 37.7% | |
PNI | Absent | 115 | 71% |
Present | 47 | 29% | |
Pattern of invasion | Cohesive | 92 | 56.8% |
Aggressive | 70 | 43.2% | |
DOI (mm) | ≤6.5 | 95 | 58.6% |
>6.5 | 67 | 41.4% | |
ECS | Absent | 122 | 75.3% |
Present | 40 | 24.7% | |
Lymph node size (cm) | ≤2.95 | 116 | 71.6% |
>2.95 | 46 | 28.4% | |
Mandibulectomy: | Marginal | 42 | 25.9% |
Segmental | 120 | 74.1% | |
Management of neck: | Ipsilateral SND | 130 | 80.24% |
Ipsilateral MRND | 28 | 17.3% | |
Ipsilateral MRND + contralateral SND | 4 | 2.5% | |
Adjuvant treatment: | No adjuvant therapy | 72 | 44.4% |
Radiotherapy | 70 | 43.2% | |
Chemoradiation | 20 | 12.3% |
Univariate Regression | OR | 95% C.I. | p Value | OR | 95% C.I | p Value | ||||
---|---|---|---|---|---|---|---|---|---|---|
Lower | Upper | Lower | Upper | |||||||
BM | multivariate regression | Site | 0.830 | 0.639 | 1.079 | 0.165 | ||||
FOM | 2.746 | 0.782 | 9.643 | 0.115 | size | 0.940 | 0.537 | 1.645 | 0.828 | |
Mn alveolus | 1.701 | 0.501 | 5.782 | 0.395 | DOI | 2.810 | 1.200 | 6.580 | 0.017 | |
RMT | 1.266 | 0.295 | 5.439 | 0.751 | GRADING | 1.353 | 0.854 | 2.141 | 0.197 | |
TONGUE | 0.359 | 0.101 | 1.276 | 0.114 | LVI | 0.865 | 0.273 | 2.738 | 0.805 | |
pT 2 | PNI | 2.162 | 0.607 | 7.706 | 0.234 | |||||
pT 3 | 1.140 | 0.199 | 6.544 | 0.883 | PATTERN | 8.870 | 3.825 | 20.570 | 0.000 | |
pT4 | 0.788 | 0.141 | 4.409 | 0.787 | LN size | 1.907 | 0.573 | 6.352 | 0.293 | |
DOI ≤ 6.5 | ||||||||||
DOI > 6.5 mm | 3.273 | 1.283 | 8.348 | 0.013 | ||||||
Well differentiated | ||||||||||
Moderate | 0.702 | 0.253 | 1.946 | 0.496 | ||||||
Poor | 1.843 | 0.700 | 4.853 | 0.216 | ||||||
LVI absent | ||||||||||
LVI present | 0.810 | 0.237 | 2.772 | 0.738 | ||||||
PNI absent | ||||||||||
PNI present | 2.955 | 0.738 | 11.830 | 0.126 | ||||||
Cohesive pattern | ||||||||||
Aggressive pattern | 10.748 | 4.222 | 27.357 | <0.001 | ||||||
LN size ≤ 2.95 | ||||||||||
LN size > 2.95 cm | 3.544 | 0.917 | 13.705 | 0.067 |
Univariate Regression | OR | 95% C.I. | p Value | OR | 95% C.I. | p Value | ||||
---|---|---|---|---|---|---|---|---|---|---|
Lower | Upper | Lower | Upper | |||||||
BM | multivariate regression | Site | 0.804 | 0.604 | 1.071 | 0.136 | ||||
FOM | 1.586 | 0.431 | 5.842 | 0.488 | pT | 1.525 | 0.797 | 2.917 | 0.203 | |
Mn alveolus | 0.767 | 0.199 | 2.956 | 0.700 | DOI | 6.486 | 2.453 | 17.144 | <0.001 | |
Tongue | 0.916 | 0.159 | 5.288 | 0.922 | GRADING | 1.455 | 0.860 | 2.461 | 0.162 | |
Site_1(4) | 0.492 | 0.139 | 1.743 | 0.272 | LVI | 2.156 | 0.591 | 7.864 | 0.245 | |
pT2 | 0.753 | PNI | 1.419 | 0.326 | 6.173 | 0.641 | ||||
pT3 | 0.946 | 0.131 | 6.827 | 0.956 | PATTERN | 11.448 | 4.414 | 29.693 | <0.001 | |
pT4a | 1.504 | 0.223 | 10.145 | 0.675 | ||||||
pT4b | 2.319 | 0.138 | 38.897 | 0.559 | ||||||
DOI ≤ 6.5 | ||||||||||
DOI > 6.5 | 7.155 | 2.547 | 20.099 | <0.001 | ||||||
Well differentiated | ||||||||||
Moderate | 1.866 | 0.635 | 5.483 | 0.257 | ||||||
Poor | 1.993 | 0.682 | 5.823 | 0.207 | ||||||
LVI absent | ||||||||||
LVI present | 2.109 | 0.569 | 7.820 | 0.265 | ||||||
PNI absent | ||||||||||
PNI present | 1.475 | 0.324 | 6.711 | 0.615 | ||||||
Cohesive pattern | ||||||||||
Aggressive pattern | 11.516 | 4.332 | 30.611 | <0.001 |
Univariate Regression | OR | 95% C.I. | p Value | Multivariate Regression | OR | 95% C.I. | p Value | ||
---|---|---|---|---|---|---|---|---|---|
Lower | Upper | Lower | Upper | ||||||
BM | Site | 0.318 | 0.073 | 1.383 | 0.127 | ||||
FOM | 0.371 | 0.091 | 1.510 | 0.166 | pT | 1.120 | 0.592 | 2.118 | 0.728 |
Mn alveolus | 0.296 | 0.067 | 1.311 | 0.109 | DOI | 0.845 | 0.357 | 2.005 | 0.703 |
RMT | 0.955 | 0.193 | 4.723 | 0.955 | GRADING | 0.858 | 0.533 | 1.381 | 0.528 |
Tongue | 3.684 | 0.908 | 14.941 | 0.068 | LVI | 1.503 | 0.483 | 4.674 | 0.481 |
pT2 | PNI | 0.575 | 0.153 | 2.158 | 0.412 | ||||
pT3 | 8.302 | 0.490 | 140.752 | 0.143 | PATTERN | 1.293 | 0.406 | 4.120 | 0.663 |
pT4a | 9.276 | 0.558 | 154.324 | 0.120 | LN size | 19.152 | 5.827 | 62.946 | <0.001 |
pT4b | 5.540 | 0.217 | 141.512 | 0.300 | |||||
DOI ≤ 6.5 | |||||||||
DOI > 6.5 | 0.563 | 0.215 | 1.478 | 0.244 | |||||
Well differentiated | |||||||||
Moderate | 1.317 | 0.344 | 5.041 | 0.688 | |||||
Poor | 0.977 | 0.338 | 2.829 | 0.966 | |||||
LVI absent | |||||||||
LVI present | 1.491 | 0.433 | 5.140 | 0.527 | |||||
PNI absent | |||||||||
PNI present | 0.703 | 0.165 | 3.003 | 0.634 | |||||
Cohesive pattern | |||||||||
Aggressive pattern | 1.689 | 0.471 | 6.053 | 0.421 | |||||
LN size ≤ 2.95 | |||||||||
LN size > 2.95 | 27.795 | 6.953 | 111.119 | 0.000 |
Mean and Median Survival Time (in Months) | ||||||||
---|---|---|---|---|---|---|---|---|
PATTERN | Mean | Median | ||||||
Estimate | Std. Error | 95% Confidence Interval | Estimate | Std. Error | 95% Confidence Interval | |||
Lower Bound | Upper Bound | Lower Bound | Upper Bound | |||||
Cohesive | 40.521 | 2.057 | 36.489 | 44.553 | 34.000 | 3.294 | 27.544 | 40.456 |
Aggressive | 34.430 | 2.472 | 29.585 | 39.275 | 28.000 | 2.564 | 22.974 | 33.026 |
pT | ||||||||
T2 | 47.932 | 5.165 | 37.808 | 58.056 | ||||
T3 | 38.072 | 2.559 | 33.057 | 43.086 | 34.000 | 8.772 | 16.808 | 51.192 |
T4a | 37.629 | 2.344 | 33.034 | 42.223 | 33.000 | 0.581 | 31.862 | 34.138 |
T4b | 26.364 | 3.718 | 19.077 | 33.651 | 24.000 | 2.752 | 18.605 | 29.395 |
GRADING | ||||||||
Well | 51.016 | 2.214 | 46.676 | 55.356 | ||||
Moderate | 34.065 | 2.353 | 29.452 | 38.677 | 33.000 | 1.301 | 30.450 | 35.550 |
Poor | 26.022 | 2.362 | 21.391 | 30.652 | 21.000 | 1.634 | 17.798 | 24.202 |
LVI | ||||||||
Absent | 41.337 | 2.117 | 37.188 | 45.487 | 41.000 | 8.703 | 23.943 | 58.057 |
Present | 33.374 | 2.359 | 28.751 | 37.997 | 30.000 | 2.279 | 25.533 | 34.467 |
PNI | ||||||||
Absent | 40.710 | 1.959 | 36.871 | 44.549 | 40.000 | 6.489 | 27.281 | 52.719 |
Present | 31.908 | 2.657 | 26.701 | 37.115 | 28.000 | 1.424 | 25.209 | 30.791 |
MANDIBULAR INVASION | ||||||||
Absent | 45.664 | 2.298 | 41.160 | 50.169 | 55.000 | 4.125 | 46.914 | 63.086 |
Present | 31.279 | 1.879 | 27.596 | 34.962 | 27.000 | 1.845 | 23.383 | 30.617 |
LYMPH NODE METASTASIS | ||||||||
Absent | 44.089 | 2.146 | 39.883 | 48.296 | 49.000 | 9.114 | 31.136 | 66.864 |
Present | 30.720 | 2.140 | 26.526 | 34.914 | 26.000 | 2.087 | 21.909 | 30.091 |
ECS | ||||||||
Absent | 40.082 | 2.066 | 36.032 | 44.132 | 34.000 | 3.486 | 27.168 | 40.832 |
Present | 34.337 | 2.624 | 29.193 | 39.481 | 28.000 | 2.703 | 22.702 | 33.298 |
DOI_1 | ||||||||
≤6.5 | 44.898 | 2.160 | 40.664 | 49.132 | ||||
>6.5 | 30.123 | 1.989 | 26.225 | 34.020 | 26.000 | 2.237 | 21.615 | 30.385 |
LN_size | ||||||||
≤2.95 | 42.952 | 1.878 | 39.271 | 46.633 | 49.000 | 6.286 | 36.680 | 61.320 |
>2.95 | 26.657 | 2.263 | 22.221 | 31.092 | 24.000 | 1.270 | 21.512 | 26.488 |
Site | ||||||||
BM | 35.459 | 2.904 | 29.767 | 41.151 | 30.000 | 3.839 | 22.475 | 37.525 |
FOM | 39.326 | 3.498 | 32.469 | 46.182 | 49.000 | 14.004 | 21.553 | 76.447 |
Mandibular alveolus | 38.319 | 4.182 | 30.122 | 46.515 | 36.000 | 8.472 | 19.395 | 52.605 |
RMT | 36.857 | 3.409 | 30.176 | 43.538 | 33.000 | 2.455 | 28.188 | 37.812 |
TONGUE | 39.126 | 3.635 | 32.002 | 46.250 | 34.000 | 6.270 | 21.711 | 46.289 |
Overall | 37.918 | 1.604 | 34.774 | 41.063 | 33.000 | 1.982 | 29.116 | 36.884 |
PATTERN | Frequency | p Value | OR | Lower 95% CI | Upper 95% CI |
---|---|---|---|---|---|
Cohesive | 92 | ||||
Aggressive | 70 | 0.046 | 1.560 | 1.008 | 2.414 |
pT | |||||
T2 | 12 | ||||
T3 | 63 | 0.063 | 3.915 | 0.928 | 16.511 |
T4a | 76 | 0.048 | 4.207 | 1.014 | 17.451 |
T4b | 11 | 0.004 | 9.407 | 2.074 | 42.659 |
GRADING | |||||
Well | 72 | ||||
Moderate | 47 | <0.001 | 3.902 | 1.983 | 7.680 |
Poor | 43 | <0.001 | 7.629 | 3.987 | 14.598 |
LVI | |||||
Absent | 101 | ||||
Present | 61 | 0.019 | 1.688 | 1.091 | 2.610 |
PNI | |||||
Absent | 115 | ||||
Present | 47 | 0.008 | 1.816 | 1.165 | 2.831 |
MANDIBULAR INVASION | |||||
Absent | 76 | ||||
Present | 86 | <0.001 | 8.467 | 4.234 | 16.934 |
LYMPH NODE METASTASIS | |||||
Absent | 94 | ||||
Present | 68 | <0.001 | 12.172 | 5.596 | 26.475 |
ECS | |||||
Absent | 122 | ||||
Present | 40 | <0.001 | 8.411 | 3.862 | 18.317 |
DOI | |||||
≤6.5 | 95 | ||||
>6.5 | 67 | <0.001 | 2.924 | 1.860 | 4.597 |
LN size | |||||
≤2.95 | 116 | ||||
>2.95 | 46 | <0.001 | 4.476 | 2.838 | 7.058 |
SITE | |||||
BM | 40 | ||||
FOM | 35 | 0.478 | 0.793 | 0.419 | 1.503 |
Mandibular alveolus | 32 | 0.901 | 0.959 | 0.493 | 1.864 |
RMT | 22 | 0.832 | 0.928 | 0.464 | 1.856 |
TONGUE | 33 | 0.514 | 0.798 | 0.405 | 1.571 |
Total | 162 |
OR | 95.0% CI for Exp(B) | p Value | ||
---|---|---|---|---|
Lower | Upper | |||
DOI | 0.987 | 0.565 | 1.722 | 0.963 |
GRADING | 1.284 | 0.889 | 1.853 | 0.182 |
LVI | 0.834 | 0.392 | 1.776 | 0.638 |
PNI | 0.730 | 0.337 | 1.581 | 0.425 |
pT | 1.213 | 0.882 | 1.668 | 0.235 |
MANDIBULAR INVASION | 2.274 | 1.006 | 5.144 | 0.048 |
ECS | 2.762 | 1.106 | 6.898 | 0.030 |
PATTERN | 2.065 | 1.152 | 3.703 | 0.015 |
LN size | 1.903 | 1.037 | 3.491 | 0.038 |
LYMPHNODE METASTASIS | 2.790 | 1.056 | 7.367 | 0.038 |
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Share and Cite
Bera, R.N.; Tripathi, R. Factors Influencing Mandibular Invasion, Lymph Node Metastasis and Extracapsular Spread in Squamous Cell Carcinoma of the Oral Cavity. Craniomaxillofac. Trauma Reconstr. 2025, 18, 30. https://doi.org/10.3390/cmtr18030030
Bera RN, Tripathi R. Factors Influencing Mandibular Invasion, Lymph Node Metastasis and Extracapsular Spread in Squamous Cell Carcinoma of the Oral Cavity. Craniomaxillofacial Trauma & Reconstruction. 2025; 18(3):30. https://doi.org/10.3390/cmtr18030030
Chicago/Turabian StyleBera, Rathindra Nath, and Richik Tripathi. 2025. "Factors Influencing Mandibular Invasion, Lymph Node Metastasis and Extracapsular Spread in Squamous Cell Carcinoma of the Oral Cavity" Craniomaxillofacial Trauma & Reconstruction 18, no. 3: 30. https://doi.org/10.3390/cmtr18030030
APA StyleBera, R. N., & Tripathi, R. (2025). Factors Influencing Mandibular Invasion, Lymph Node Metastasis and Extracapsular Spread in Squamous Cell Carcinoma of the Oral Cavity. Craniomaxillofacial Trauma & Reconstruction, 18(3), 30. https://doi.org/10.3390/cmtr18030030