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Nodal Volume as a Prognostic Factor in Oral Tongue Cancer with Cervical Lymph Node Metastasis

Objectives Oral tongue cancer is the most prevalent type of oral cavity
cancer and presents the worst prognosis. With the use of tumor, lymph
node, distant metastasis (TNM) staging system, only the tumor and lymph
node size are taken into account. However, several studies have
considered the tumor volume as a possible significant prognostic factor
of oral tongue cancer with cervical lymph node metastasis. Our study,
therefore, aimed to explore the prognostic implications of the relevant
nodal volume. Design, Setting and Participants Medical records and
imaging (either from computed tomography scan, CT scan or magnetic
resonance imaging scan, MRI scan) of 70 patients diagnosed with oral
tongue cancer with cervical lymph node metastasis between January 2011
and December 2016 were retrospectively reviewed. Main outcome measures
The nodal volume was measured from the imaging using the Eclipse
application (Version 15.6.05, Varian company) and was further analyzed
for its prognostic implications, particularly on overall survival,
disease-free survival, and distant metastasis-free survival. Results
From a receiver operating characteristic (ROC) curve analysis, the
optimal cut-off value of the nodal volume was 3.95 cm3, to predict the
disease prognosis, in terms of overall survival and metastatic-free
survival (p= <0.001 and p=0.005, respectively), but not the
disease-free survival (p=0.241). For the multivariable analysis, the
nodal volume, but not TNM staging, was a significant prognostic factor
for distant metastasis (HR=4.5, 95%CI 1.1-17.94, p=0.036 vs p=0.459,
respectively). Conclusions In patients with oral tongue cancer and
cervical lymph node metastasis, the presence of a nodal volume of 3.95
cm3 was a poor prognostic factor for distant metastasis. Therefore, the
lymph node volume from the current imaging protocol may be useful in
adjunct with the current staging system to predict the disease prognosis