Elective neck dissection in early-stage oral squamous cell carcinoma--does it influence recurrence and survival?
BACKGROUND
This study investigates the influence on survival and regional control rates of neck dissection therapy at the time of surgery of the primary tumor in early stages of squamous cell carcinoma (SCC) of the oral cavity.


METHODS
A series of 154 patients with pT1N0M0 and pT2N0M0 intraoral carcinomas was analyzed retrospectively. Neck dissection was associated with tumor ablation in 87 patients (56.5%), although 67 patients (43.5%) were treated with local resection exclusively. Survival and relapse rates were studied with the Kaplan-Meier curves and the log-rank test for univariate analysis and Cox proportional model for multivariate analysis (p < .05).


RESULTS
Regional recurrences occurred in 25 cases (16.2%), 7 cases (8%) with primary neck dissection and 18 cases (26.8%) with local excision alone. Neck dissection therapy was a significant prognostic factor for recurrences and survival (p < .05). The 5-year regional control rate was of 92.5% for patients with elective lymph node ablation versus 71.2% for patients without primary neck dissection. Neck dissection was also significant for recurrences in stage I and for survival and recurrences in stage II. Neck dissection therapy also showed independent prognostic value in the Cox analysis.


CONCLUSIONS
In patients with intraoral carcinomas, elective neck treatment should be considered even in cases with a small primary tumor and negative clinical examination because of the high incidence of occult nodal metastases and the tendency to regional recurrences.
Capote
Ana
A
Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, Universidad Autonoma of Madrid, Spain. anacapote@inicia.es
Escorial
Veronica
V
Muñoz-Guerra
Mario F
MF
Rodríguez-Campo
Francisco J
FJ
Gamallo
Carlos
C
Naval
Luis
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000601:surgery; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000401:mortality* / Q000601:surgery; D015999:Multivariate Analysis; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology