Objective: The aim of this study is to investigate the clinical and pathological factors related to distant metastasis in patients with oral cavity squamous cell carcinoma (OCSCC) undergoing surgery. Study Design: A retrospective data review was conducted on patients who underwent primary surgery for OCSCC at the Instituto do Cancer do Estado de São Paulo (ICESP) between 2009 and 2015. Distant metastasis rates were calculated and predictive factors were determined by the Cox proportional-hazards model. Results: There was a total of 274 patients, including 210 (76.6%) men and 64 (23.4%) women, with a mean age of 59.9 ± 10.9 years. The incidence of distant metastasis was 9.6%, with the lung being the most common site. The mean time interval between surgical treatment and the diagnosis of distant metastasis was 12 months (range 2–40 months). In the multivariate analysis, angiolymphatic invasion (HR = 2,87; p = 0.023), contralateral cervical metastasis (HR = 3.3; p = 0,007), tumor thickness >25 mm (HR = 3.50; p = 0.009), and locoregional recurrence (HR = 6.59; p < 0.0001) were the only independent risk factors for distant metastasis. Conclusion: Patients with OCSCC who have contralateral lymph node metastasis, tumors with a thickness >25 mm, angiolymphatic invasion, or locoregional recurrence after surgical treatment have a greater risk of developing distant metastasis.

Keywords:
Oral cancer, Metastasis, Squamous cell carcinoma, Risk factors
1.
Siegel RL, Miller KD, Jemal A: Cancer statistics, 2017. CA Cancer J Clin 2017; 67: 7–30.
2.
Lim JY, Lim YC, Kim SH, Kim JW, Jeong HM, Choi EC: Predictive factors of isolated distant metastasis after primary definitive surgery without systemic treatment for head and neck squamous cell carcinoma. Oral Oncol 2010; 46: 504–508.
3.
Coca-Pelaz A, Rodrigo JP, Suárez C: Clinicopathologic analysis and predictive factors for distant metastases in patients with head and neck squamous cell carcinomas. Head Neck 2012; 34: 771–775.
4.
León X, Quer M, Orús C, del Prado Venegas M, López M: Distant metastases in head and neck cancer patients who achieved loco-regional control. Head Neck 2000; 22: 680–686.
5.
Alvi A, Johnson JT: Development of distant metastasis after treatment of advanced-stage head and neck cancer. Head Neck 1997; 19: 500–505.
6.
Sumioka S, Sawai NY, Kishino M, Ishihama K, Minami M, Okura M: Risk factors for distant metastasis in squamous cell carcinoma of the oral cavity. J Oral Maxillofac Surg 2013; 71: 1291–1297.
7.
Garavello W, Ciardo A, Spreafico R, Gaini RM: Risk factors for distant metastases in head and neck squamous cell carcinoma. Arch Otolaryngol Head Neck Surg 2006; 132: 762–766.
8.
Liao CT, Wang HM, Chang JT, Ng SH, Hsueh C, Lee LY, Lin CH, Chen IH, Huang SF, Yen TC: Analysis of risk factors for distant metastases in squamous cell carcinoma of the oral cavity. Cancer 2007; 110: 1501–1508.
9.
Sakamoto Y, Matsushita Y, Yamada S, Yanamoto S, Shiraishi T, Asahina I, Umeda M: Risk factors of distant metastasis in patients with squamous cell carcinoma of the oral cavity. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121: 474–480.
10.
Chen TC, Hsu CW, Lou PJ, Ko JY, Yang TL, Chen CN, Chang YL, Wang CP: The clinical predictive factors for subsequent distant metastasis in patients with locoregionally advanced oral squamous cell carcinoma. Oral Oncol 2013; 49: 367–373.
11.
Hasegawa T, Tanakura M, Takeda D, Sakakibara A, Akashi M, Minamikawa T, Komori T: Risk factors associated with distant metastasis in patients with oral squamous cell carcinoma. Otolaryngol Head Neck Surg 2015; 152: 1053–1060.
12.
Kowalski LP, Carvalho AL, Martins Priante AV, Magrin J: Predictive factors for distant metastasis from oral and oropharyngeal squamous cell carcinoma. Oral Oncol 2005; 41: 534–541.
13.
Li X, Di B, Shang Y, Zhou Y, Cheng J, He Z: Clinicopathologic risk factors for distant metastases from head and neck squamous cell carcinomas. Eur J Surg Oncol 2009; 35: 1348–1353.
14.
Rahima B, Shingaki S, Nagata M, Saito C: Prognostic significance of perineural invasion in oral and oropharyngeal carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 97: 423–431.
15.
Adel M, Kao HK, Hsu CL, Huang JJ, Lee LY, Huang Y, Browne T, Tsang NM, Chang YL, Chang KP: Evaluation of lymphatic and vascular invasion in relation to clinicopathological factors and treatment outcome in oral cavity squamous cell carcinoma. Medicine 2015; 94:e1510.
16.
Pinto FR, de Matos LL, Palermo FC, Kulcsar MA, Cavalheiro BG, de Mello ES, Alves VA, Cernea CR, Brandão LG: Tumor thickness as an independent risk factor of early recurrence in oral cavity squamous cell carcinoma. Eur Arch Otorhinolaryngol 2014; 271: 1747–1754.
17.
Matos LL, Manfro G, Santos RV, Stabenow E, Mello ES, Alves VA, Pinto FR, Kulcsar MA, Brandão LG, Cernea CR: Tumor thickness as a predictive factor of lymph node metastasis and disease recurrence in T1N0 and T2N0 squamous cell carcinoma of the oral tongue. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118: 209–217.
© 2018 S. Karger AG, Basel
2018
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.