Abstract

Backgrounds The optimal method of management of clinical N0 neck in squamous cell carcinoma (SCC) of the oral cavity remains controversial. In 1994 Weiss et al. recommended with decision analysis that when the probability of occult cervical metastasis is more than 20% (treatment threshold), the neck should be electively treated. Recently, we calculated the treatment threshold as 44.4% on patients treated between 1991 and 2006. In order to explore this gross discrepancy, we conducted the decision sensitivity analysis on patients treated between 1987 and 2000 compared with those treated between 2001 and 2009. Results Between 1987 and 2009 we treated 270 consecutive patients with previously untreated SCC of the oral cavity and N0 neck. Among three variables leading to the treatment threshold, the 5-year overall survival rate for patients whose necks were observed and harbored occult metastasis was significantly different between two treatments periods. The rate was 83.3% since 2001, significantly higher than 47.1% until 2000. On the contrary, other variables were constant. The 5-year overall survival rate for the patients who received elective neck dissection (END) with no neck recurrence was 88.2% until 2001 and was the same rate as 88.1% until 2000. The 5-year overall survival rate for the patients whose N0 necks were observed without END and had no neck recurrence was 96.8% since 2001 and the rate was 95.7% until 2000. Thereby, the treatment threshold was calculated to be 22.8% until 2000 and 93.5% since 2001, respectively. Conclusion The survival rate for these observed patients can be improved to the comparable rate for patients who underwent elective neck dissection and were verified to have occult metastatic nodes. The improvement thereby permits wait-and-see policy for patients with N0 neck.

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