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Objectives <p>This study aimed to investigate the incidence, prognostic impact, and preoperative predictive factors of cervical lymph node metastasis (CLM) in patients with clinically node-negative (cN0) lower gingival squamous cell carcinoma (SCC) treated with marginal mandibulectomy, with particular focus on biopsy-based pathological parameters.</p> Materials and methods <p>Forty-two patients with cN0 lower gingival SCC who underwent marginal mandibulectomy as initial treatment were retrospectively analysed. Clinical findings and histopathological features assessed using biopsy specimens included tumour differentiation grade, Yamamoto–Kohama mode of invasion, tumour budding (TB), mitotic count, and buccal mucosal invasion. Associations with CLM and survival outcomes were statistically evaluated. Multivariate logistic regression analysis was performed to identify independent predictors of CLM.</p> Results <p>CLM occurred in 12 of 42 cases (28.6%), including late CLM in six cases. Multivariate analysis identified a budding score (BS) ≥ 5 and buccal mucosal invasion as independent predictors of CLM. Patients with CLM showed significantly poorer 5-year disease-specific survival (5y-DSS) than those without CLM (59.4% vs. 100%, <i>P</i> = 0.003). BS ≥ 5 was also significantly associated with worse 5y-DSS (<i>P</i> = 0.012). A combined model incorporating BS ≥ 5 and buccal mucosal invasion (BB model) demonstrated high specificity for predicting CLM.</p> Conclusions <p>Even in patients with early-stage lower gingival SCC eligible for marginal mandibulectomy without bone marrow invasion, CLM occurs at a considerable frequency and significantly affects prognosis. Preoperative risk stratification using biopsy-based BS and buccal mucosal invasion may facilitate selective application of elective neck dissection and contribute to improved oncological outcomes.</p> Clinical relevance <p>TB and buccal mucosal invasion assessed in biopsy specimens are useful preoperative predictors of CLM in early-stage lower gingival SCC and may aid in optimising neck management strategies.</p>

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Treatment strategy for cervical lymph node metastases in patients with lower gingival carcinoma undergoing mandibular marginal resection

  • 期刊论文

  • 发表日期：

    2026年5月12日

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  • Masaru Ogawa,
  • Satoshi Yokoo,
  • Takahiro Yamaguchi,
  • Keisuke Suzuki,
  • Mai Seki,
  • Takaya Makiguchi

摘要

Objectives

This study aimed to investigate the incidence, prognostic impact, and preoperative predictive factors of cervical lymph node metastasis (CLM) in patients with clinically node-negative (cN0) lower gingival squamous cell carcinoma (SCC) treated with marginal mandibulectomy, with particular focus on biopsy-based pathological parameters.

Materials and methods

Forty-two patients with cN0 lower gingival SCC who underwent marginal mandibulectomy as initial treatment were retrospectively analysed. Clinical findings and histopathological features assessed using biopsy specimens included tumour differentiation grade, Yamamoto–Kohama mode of invasion, tumour budding (TB), mitotic count, and buccal mucosal invasion. Associations with CLM and survival outcomes were statistically evaluated. Multivariate logistic regression analysis was performed to identify independent predictors of CLM.

Results

CLM occurred in 12 of 42 cases (28.6%), including late CLM in six cases. Multivariate analysis identified a budding score (BS) ≥ 5 and buccal mucosal invasion as independent predictors of CLM. Patients with CLM showed significantly poorer 5-year disease-specific survival (5y-DSS) than those without CLM (59.4% vs. 100%, P = 0.003). BS ≥ 5 was also significantly associated with worse 5y-DSS (P = 0.012). A combined model incorporating BS ≥ 5 and buccal mucosal invasion (BB model) demonstrated high specificity for predicting CLM.

Conclusions

Even in patients with early-stage lower gingival SCC eligible for marginal mandibulectomy without bone marrow invasion, CLM occurs at a considerable frequency and significantly affects prognosis. Preoperative risk stratification using biopsy-based BS and buccal mucosal invasion may facilitate selective application of elective neck dissection and contribute to improved oncological outcomes.

Clinical relevance

TB and buccal mucosal invasion assessed in biopsy specimens are useful preoperative predictors of CLM in early-stage lower gingival SCC and may aid in optimising neck management strategies.