Clinicopathological Factors Associated With Level V Cervical Lymph Node Metastasis in Oral Squamous Cell Carcinoma: A Prospective Observational Study

Abstract

Background Oral squamous cell carcinoma (OSCC) is the most common malignant tumor of the oral cavity. Metastasis to level V cervical lymph nodes is relatively uncommon but is generally associated with advanced disease and more extensive cervical nodal involvement. Identifying clinicopathological factors associated with level V lymph node metastasis may assist clinicians in surgical planning and pathological risk assessment. Therefore, this study aimed to evaluate the association between selected clinicopathological factors and pathological level V cervical lymph node metastasis in patients with OSCC. Methods A prospective observational study was conducted at Krishna Institute of Medical Sciences, Secunderabad, Telangana, India, between November 2022 and March 2024. A total of 120 patients with histopathologically confirmed OSCC who underwent definitive surgical treatment were included. Clinical and pathological variables evaluated included tumor size, tumor site, lymphovascular invasion (LVI), perineural invasion (PNI), tumor stage, and extranodal extension (ENE). All cervical lymph nodes dissected during surgery, including those from level V, were submitted separately for histopathological examination. Descriptive statistics were used to summarize the data, while the chi-square test or Fisher's exact test was used to evaluate associations between categorical variables using SPSS (SPSS Statistics for Windows, version 17; SPSS Inc., Chicago, IL). Results In the advanced tumor stage, the presence of LVI, PNI, and ENE was significantly associated with pathological level V lymph node metastasis. Level V metastasis was more frequently observed among patients with advanced cervical nodal disease and adverse histopathological characteristics. Conclusion Level V cervical lymph node metastasis was uncommon but was predominantly observed in patients with advanced clinicopathological disease characteristics. Larger tumor size, advanced tumor stage, LVI, PNI, ENE, and more extensive cervical nodal involvement were significantly associated with pathological level V lymph node metastasis. These findings may assist clinicians during preoperative assessment and surgical planning; however, they should be interpreted as associations rather than independent predictive factors. Further multicenter studies are required to validate these findings.