Comparative Survival Analysis Between Pathological N3B Nodal Disease and Other Node Positive Patients of Oral Squamous Cell Carcinoma and Their Management in Current Practice - Single Centre Experience.

Abstract Background Regional nodal metastasis with extra nodal extension (ENE) in patients of oral cavity squamous cell carcinoma (OCSCC) has a low survival in spite of aggressive multimodality therapeutic approach. Till now there is no level I data for decision making, and optimal treatment for N3b nodal disease. We aim at providing our institutional experience on survival analysis of N3b nodal disease in OCSCC, including its pattern on loco regional & distant recurrence. Methods Retrospective analysis of all diagnosed nodal positive 199 patients (from January 2019 to December 2020 ) of OCSCC was done. These patients underwent surgery followed by adjuvant therapy & were followed up for atleast 2 years. Results 199 patients underwent surgery. 89 (44.7%) patients had pN3b disease & 110 patients (55.3%) had non-N3b disease (N1 to N3a). 2-year overall survival for pN3b & non N3b was 58.2% & 97.1% (P = 0.0023). Most common sites of distant metastasis were lung, bone, liver. 33 (37.1%) patients from N3b cohort and 20 (18.2%) patients from non N3b cohort had recurrence within 2 years. Interestingly, patients in N3b cohort, commonly had loco regional recurrence (primary site > neck node > satellite nodules). Conclusions OCSCC with N3b nodes is an aggressive subtype with poor prognosis in spite of R0 resection and adjuvant therapy. Maintenance with Metronomic / Immunotherapy at least for initial 2 years should be considered. There is a pressing need to identify N3b status on pre-operative radiology & consider neoadjuvant immunotherapy +/- CT.