195 MET and nodal metastasis Table 5: multivariable binary logistic regression model investigating the independent effect of MET positivity and DOI > 4 mm on pN+ for all cancers (n=102) and cN0 cancers (n=90). Variable All patients (n=102) cN0 patient (n=90) Odds ratio 95% CI p-value Odds ratio 95% CI p-value MET positivity 3.66 1.47 – 9.06 0.005 4.28 1.45 – 12.65 0.009 DOI > 4mm 2.05 0.67 – 6.30 0.209 2.16 0.55 – 8.53 0.274 Constant 0.12 0.000 0.073 0.000 Significance p-value = 0.005 p-value = 0.009 A 2 x 2 table for pN+ cancers (n=30), depicting the number of cancers either negative (< 10% uniform positivity) or positive for MET versus DOI ≤ or > 4 mm, illustrates that there were 2 (6.67%) MET negative cancers with LNM in the group DOI ≤ 4 mm. Three (10.0%) cancers with LNM were MET positive and had a DOI ≤ 4 mm. Eight (26.7%) cancers with LNM were MET negative and had a DOI > 4 mm. Seventeen (56.7%) cancers with LNM were MET positive and had a DOI > 4 mm (Table 6). A similar 2 x 2 table for cases with occult LNM (n=20) shows 1 (5.00%) MET negative cancer with occult LNM with DOI ≤ 4 mm. Two (10.0%) cancers with occult LNM were MET positive and had a DOI ≤ 4 mm. Five (25.0%) cancers with occult LNM were MET negative and had a DOI > 4 mm. Twelve (60.0%) cancers with occult LNM were MET positive and had a DOI > 4 mm (Table 6). These numbers illustrated the potential additive value of MET positivity to DOI > 4 mm to assess the presence of LNM (pN+ and occult). Table 6: 2 x 2 tables showing the relationship between MET positivity and DOI status in cancers with pN+ (n=30) and cancers with occult LNM (n=20). Cancers with pN+ (n=30) Cancers with occult LNM (n=20) DOI ≤ 4 mm DOI > 4 mm DOI ≤ 4 mm DOI > 4 mm MET negative 2 (6.67%) 8 (26.7%) 1 (5.00%) 5 (25.0%) MET positive 3 (10.0%) 17 (56.7%) 2 (10.0%) 12 (60.0%) Discussion For patients with early OSCC, END is generally recommended when the chance of occult lymph node metastasis is more than 20% (2, 4, 24-26). DOI is one of the most reliable parameters to predict occult LNM and guide clinical decision making on END. At our center DOI cut-off value > 4 mm is used. DOI is usually determined days after initial surgery based on the final histopathological assessment. As such, END is often performed during second surgery when DOI is > 4 mm. There is a need for 6
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