Neck Management in cT1N0 Tongue Squamous Cell Carcinoma as Determined by Sonographic Depth of Invasion.

Yao Wu,Wei Du,Liyuan Dai,Qigen Fang,Xu Zhang

doi:10.3389/fonc.2021.786258

Yao Wu, Wei Du + Show 3 more

Open Access

https://doi.org/10.3389/fonc.2021.786258

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Abstract

ObjectivesTo compare the oncologic outcomes in patients with cT1N0 tongue squamous cell carcinoma (SCC) who underwent different neck management strategies stratified by sonographic depth of invasion (DOI).MethodsThe included patients were retrospectively enrolled, and divided into two groups: observation (OBS) and elective neck dissection (END). The regional control (RC) and disease-specific survival (DSS) rates were compared and stratified by sonographic DOI.ResultsThe mean sonographic and pathologic DOIs were 3.8 and 3.7 mm, respectively; the two DOIs were significantly correlated (Spearman correlation coefficient 0.974. p <0.001). In patients with sonographic DOI <4.0 mm, the 5-year RC rates were 73 and 89% in the OBS and END groups, respectively, and were not significantly different. However, in patients with sonographic DOI ≥4.0 mm, the 5-year RC rate was significantly different between the OBS (57%) and END (80%) groups (p = 0.031). In patients with sonographic DOI <4.0 mm, the 5-year DSS rates were 79 and 89% in OBS and END groups, respectively, and were not significantly different. However, in patients with sonographic DOI ≥4.0 mm, the 5-year DSS rate was significantly different between the OBS (67%) and END (86%) groups (p = 0.033).ConclusionsSonographic DOI was notably correlated with pathologic DOI. Moreover, there was a significant survival difference between the OBS and END groups in cT1N0 tongue SCC patients with sonographic DOI ≥4.0 mm but not in those with sonographic DOI <4.0 mm. Our study provides a useful method to aid decision-making in the clinical setting for this patient group.

Highlights

Surgical excision is the preferred method for managing squamous cell carcinoma (SCC) of the tongue, which is the most common oral malignancy [1]
Pathologic neck lymph node metastasis occurred in 12 patients (10.6%, 12/113), of whom six received suprahyoid neck dissection (SOND) and six received modified radical neck dissection (MRND)
The most important finding in this study was that the sonographic DOI corresponded with pathologic DOI

Summary

Introduction

Surgical excision is the preferred method for managing squamous cell carcinoma (SCC) of the tongue, which is the most common oral malignancy [1]. Neck dissection is usually included in the initial treatment of cT3–T4 disease; the optimal neck management in cases of cT1N0 tongue SCC is still controversial owing to the wide range of the occult metastasis rate [2]. Vandenbrouck et al [3], Fakih et al [4], and Yuen et al [5] reported that a comparison of oncologic outcomes between patients undergoing OBS and those indicated for END revealed a similar diseasespecific survival (DSS) in both groups. Some highquality studies showed that END could reduce the frequency of regional nodal recurrence and improve DSS in patients with cT1-2N0 oral SCC [6,7,8]. To achieve successful outcomes in such cases, reliable predictors indicating cervical lymph node metastasis, which can be assessed preoperatively, must be identified

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