Neck observation versus elective neck dissection in management of clinical T1/2N0 oral squamous cell carcinoma: a retrospective study of 232 patients

Objective: The management of early-stage (cT1/2N0) oral squamous cell carcinoma (OSCC) remains a controversial issue. The aim of this study was to compare the clinical outcomes of neck observation (OBS) and elective neck dissection (END) in treating patients with cT1/2N0 OSCC. Methods: A total of 232 patients with cT1/2N0 OSCC were included in this retrospective study. Of these patients, 181 were treated with END and 51 with OBS. The survival curves of 5-year overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) rates were plotted using the Kaplan-Meier method for each group, and compared using the Log-rank test. Results: There was no significant difference in 5-year OS and DSS rates between END and OBS groups (OS: 89.0% vs. 88.2%, P=0.906; DSS: 92.3% vs. 92.2%, P=0.998). However, the END group had a higher 5-year RFS rate than the OBS group (90.1% vs. 76.5%, P=0.009). Patients with occult metastases in OBS group (7/51) had similar 5-year OS rate (57.1% vs. 64.1%, P=0.839) and DSS rate (71.4% vs. 74.4%, P=0.982) to those in END group (39/181). In the regional recurrence patients, the 5-year OS rate (57.1% vs. 11.1%, P=0.011) and DSS rate (71.4% vs. 22.2%, P=0.022) in OBS group (7/51) were higher than those in END group (9/181). Conclusions: The results indicated that OBS policy could obtain the same 5-year OS and DSS as END. Under close follow-up, OBS policy may be an available treatment option for patients with clinical T1/2N0 OSCC.

Elective neck dissection in early oral squamous cell carcinoma:necessary?

Aim:The indication of neck dissection in oral squamous cell carcinoma(OSCC)is a problem of risk-benefit evaluation between probability of neck metastases,the problem of complications associated with neck dissection and the prognostic influence of delayed diagnosis of metastasis during follow-up.There is no consensus on the elective treatment of the neck in early oral cancer patients with a clinically N0(cN0)neck.Methods:The author performed a search of PubMed articles with the words"elective neck dissection vs.observation","node negative neck"and"early stage oral squamous cell carcinoma".The author selected those articles that studied the early OSCC(T1-T2),and elective neck treatment was compared with clinical observation.Results:Many studies have compared the outcome of elective neck dissection(END)to observation of the neck in early OSCC.The results of them are described.The biologic aggressiveness of oral cavity squamous cell carcinoma,particularly in the early stages,is reflected in its ability to metastasize to regional lymph node chains.Many pretreatment imaging techniques to diminish the incidence of occult metastases haven been studied,and comparative studies have shown ultrasound guided fine needle aspiration cytology(USgFNAC)to be the most accurate.Conclusion:A few non-randomized studies have shown no advantages of END when strict USgFNAC follow-up was employed.Thus,if routine strict follow-up using USgFNAC by a well-trained ultrasonographer cannot be assured,END is the safest strategy.