title: Outcome of patients with early stage oral cancer managed by an observation strategy towards the N0 neck using ultrasound guided fine needle aspiration cytology: No survival difference as compared to elective neck dissection.
abstract: OBJECTIVE
  Management of the clinically N0 neck in oral cancer patients remains controversial. We describe the outcome of patients with T1-T2 oral cancer and N0 neck based on ultrasound guided fine needle aspiration cytology (USgFNAC) who were treated by transoral excision and followed by a 'wait and scan' policy (W&S).
  
  
  METHODS
  This retrospective analysis included 285 consecutive patients of whom 234 were followed by W&S and 51 underwent elective neck dissection (END). Survival rates were compared between groups and correction for confounding factors was performed.
  
  
  RESULTS
  Of W&S patients, the 5-year disease-specific (DSS) and overall survival (OS) were 94.2% and 81.6% respectively. During follow-up 72.2% remained free of lymph node metastases and 27.8% developed delayed metastases. W&S patients with delayed metastases had a 5-year DSS and OS of 80.0% and 62.8%, respectively. In patients with positive END these rates were 81.3% and 64.2%, respectively. Between the groups, survival rates were not significantly different. Of the W&S patients with delayed metastases, 90.6% needed adjuvant radiotherapy versus 55.0% of patients with positive END.
  
  
  CONCLUSIONS
  With regard to survival, in patients with early stage oral cancer and cN0 neck a 'wait and scan' policy using strict USgFNAC surveillance is justified as survival is not negatively influenced. Using a 'wait and scan' follow-up strategy instead of elective neck treatment, unnecessary neck dissection and its accompanying morbidity can be avoided in 72.2% of patients. However, for the small proportion of patients with delayed metastases, more extensive treatment with adjuvant radiotherapy is needed.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Géke B
authors.initials: GB
authors.lastname: Flach
authors.forename: Mark
authors.initials: M
authors.lastname: Tenhagen
authors.forename: Remco
authors.initials: R
authors.lastname: de Bree
authors.forename: Ruud H
authors.initials: RH
authors.lastname: Brakenhoff
authors.forename: Isaac
authors.initials: I
authors.lastname: van der Waal
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Bloemena
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Kuik
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Castelijns
authors.forename: C René
authors.initials: CR
authors.lastname: Leemans
mesh_terms: D001707:Biopsy, Needle / Q000379:methods*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D009062:Mouth Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D019370:Observation; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014463:Ultrasonography