Abstract
BackgroundThe evidence base to inform the decision making process in patients with early stage oral cancer and a clinical and radiological N0 neck remains insufficient to answer the question when it is safe to “watch and wait” and when to proceed with a selective neck dissection.MethodsA total of 327 consecutive cases of histopathologically staged T1–2, N0–1 and M0, but clinically N0, squamous cell carcinoma of the tongue were prospectively analysed. Univariate and multivariate analyses were used for statistical analysis and are represented as Kaplan-Meier analyses or Cox proportional hazard regression analysis.ResultsIn 61 patients (18.65%) lymph node involvement was found in the histopathological processing. The mean survival of all patients was 73.3 ± 48.6 months. The 2-year and 5-year overall survival rates of all patients were 87.5% and 68.4%, respectively. The 2-year and 5-year survival rates for stage N0 were 89.1% and 70.7% compared to 83.3% and 62.9% in N1 situations. The 2-year and 5-year survival rates for stage T1 were 87.9% and 73.6% compared to 87.2% and 65.3% in stage T2, respectively. The time to recurrence in stage N0 was 35.1 ± 30.5 months compared to 25.63 ± 24.6 months in cases with N1 disease. Stage T1 was associated with a time to recurrence of 38.1 ± 33.9 months compared with 27.2 ± 22.7 months in patients classified T2.Variables found to be strongly associated with survival in the univariate analysis included older age, higher tumour and N stage, and grading. Age, tumour stage (p = 0.011, 95% CI, 1.09 to 2.0), nodal stage (p = 0.038, 95% CI, 1.02 to 2.07), and recurrence were independently and significantly associated with survival in the multivariate analysis.ConclusionsThis confirms a high overall disease free survival for patients with T1 and N0 treated with single modality surgery and in common with the literature confirms the poor impact on prognosis of the N positive neck.
Highlights
The evidence base to inform the decision making process in patients with early stage oral cancer and a clinical and radiological N0 neck remains insufficient to answer the question when it is safe to “watch and wait” and when to proceed with a selective neck dissection
The management decision around small stage T1 and T2 squamous cell carcinomas (SCC) thin tumours centers around either a wait-and-see policy or a selective neck dissection of the ipsilateral lymph nodes of level I-IV, which logically should be bilateral in midline lesions [4,5]
The extent of neck dissection was performed uni- or bilaterally in level I-III of the neck, depended on the location of metastases intraoperatively [1]
Summary
The evidence base to inform the decision making process in patients with early stage oral cancer and a clinical and radiological N0 neck remains insufficient to answer the question when it is safe to “watch and wait” and when to proceed with a selective neck dissection. The incidence of pathologically positive lymph nodes in the clinically and radiologically negative neck (N0) in T1 and T2 squamous cell carcinomas (SCC) of the oral cavity remains controversial. Ablative surgery with or without reconstruction is an established therapy for small tumours staged at T1 and T2 created controversies exists around the role of neck dissection. The management decision around small stage T1 and T2 SCC thin tumours centers around either a wait-and-see policy or a selective neck dissection of the ipsilateral lymph nodes of level I-IV, which logically should be bilateral in midline lesions [4,5]. The incidence of lymph node involvement and its role in overall survival was further investigated
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