Elective neck dissection improves the survival of patients with T2N0M0 oral squamous cell carcinoma: a study of the SEER database

Abstract

Background Treatment of clinical N0 neck tumours is controversial in early-stage oral squamous cell carcinoma (OSCC), possibly because T1N0M0 and T2N0M0 merge together at early stages. The purposes of this study were to compare survival outcomes only for T2N0M0 cases based upon treatment elective neck dissection versus neck observation. Methods T2N0M0 OSCC cases were identified in the Surveillance, Epidemiology, and End Results database of the United States National Cancer Institute between 2004 and 2015. Survival curves for different variable values were generated using Kaplan-Meier estimates and compared using the log-rank test. Variables that achieved significance at P < 0.05 were entered into multivariable analyses via the Cox proportional hazards multivariate regression. Results A total of 2857 patients were selected, and 2313 cases were available for disease specific survival (DSS). The 5-year and 10-year overall survival (OS) were 66.7 and 46% for patients receiving elective neck dissection (END), respectively, and 56.4 and 37.2% for patients with neck observation (P < 0.0001). The 5-year and 10-year DSS were 73.6 and 64% for the END group, respectively, versus 64.5 and 54.5% for the neck observation group (P < 0.0001). More importantly, performing END was independently associated with favourable DSS and OS for patients with T2N0M0 OSCC [hazard ratio (HR) = 0.769, P = 0.0069 for DSS; HR = 0.829, P = 0.0031 for OS, neck observation group as reference] according to multivariate survival analysis. Conclusion END is recommended for T2N0M0 OSCC cases and it is associated with improved DSS and OS.

Is elective neck dissection justified in cT2N0M0 oral cavity cancer defined according to the AJCC eighth edition staging system?

“…The SEER study of cT2N0M0 OCSCC staged in accordance with the AJCC Seventh Edition found, in contrast to the current investigation, that there was a roughly 10% difference in the 5‐year DSS rate between those who received NO and those who underwent END. As a result, in order to manage cT2N0M0 OCSCC, the SEER investigators recommended using END 7 . It is generally expected that, the differences in DSS between patients undergoing END and those receiving NO are anticipated to decrease in proportion to the prevalence of occult cervical metastases.…”

Exploring the combination of tumor‐stroma ratio, tumor‐infiltrating lymphocytes, and tumor budding with WHO histopathological grading on early‐stage oral squamous cell carcinoma prognosis

“…15 An important concern in early-stage OSCC is the presence of lymph node metastasis (clinically detected or occult), representing a major source of recurrence and cancer-related death. 16 Although occult lymph node metastasis is found in up to 30% of the OSCCs, the fear of its devastating effects often leads to elective dissection of the neck in early-stage OSCCs, mainly in those located in the tongue, causing overtreatment in many cases, with more adverse effects and higher financial burden than what is required. 17,18 In this context, it is essential to identify reliable biomarkers to accurately identify patients with a more aggressive tumor, in whom a complex therapy is necessary.…”

“…Surgery remains the mainstay of treatment, including neck dissection for involved cervical lymph nodes as well as for staging the disease and access during reconstructive surgery 15 . An important concern in early‐stage OSCC is the presence of lymph node metastasis (clinically detected or occult), representing a major source of recurrence and cancer‐related death 16 . Although occult lymph node metastasis is found in up to 30% of the OSCCs, the fear of its devastating effects often leads to elective dissection of the neck in early‐stage OSCCs, mainly in those located in the tongue, causing overtreatment in many cases, with more adverse effects and higher financial burden than what is required 17,18 .…”

miR‐99a‐5p as a biomarker for lymph node metastasis prediction in oral squamous cell carcinoma patients

“…[17][18][19] The elective neck dissection is the gold-standard method for early-stage tumors with clinically negative cervical lymph nodes. 20 However, this approach promotes postoperative morbidities and complications, and many patients undergoing this procedure have pathological confirmation of the absence of lymph node metastasis. 21 Therefore, an accurate, quick, and easy-to-detect biomarker could be a useful tool to assist physicians during the cervical dissection decision.…”

“…The elective neck dissection is the gold‐standard method for early‐stage tumors with clinically negative cervical lymph nodes 20 . However, this approach promotes postoperative morbidities and complications, and many patients undergoing this procedure have pathological confirmation of the absence of lymph node metastasis 21 .…”