title: Is there a role for neck dissection in T1 oral tongue squamous cell carcinoma? The UCLA experience.
abstract: OBJECTIVE
  We sought to examine prognostic and therapeutic implications, including cost-effectiveness, of elective neck dissection in the management of patients with clinically-determined T1N0 oral tongue carcinoma.
  
  
  METHODS
  A retrospective review of patients with cT1N0 oral tongue squamous cell carcinoma who underwent surgical extirpation of primary tumor, with or without elective neck dissection, at UCLA Medical Center from 1990 to 2009 was performed. Cox proportional hazards regression was used to assess effects of variables on time to first loco-regional recurrence. A healthcare costs analysis of elective neck dissection was performed by querying the SEER-Medicare linked database.
  
  
  RESULTS
  Of the 123 patients identified with cT1N0 squamous cell carcinoma of the oral tongue, 88 underwent elective neck dissection at the time of tumor resection while 35 did not. For all patients, disease-free survival at 3, 5, and 10 years was 93%, 82%, and 79%. Of the 88 patients undergoing elective neck dissection, 20 (23%) demonstrated occult metastatic disease. Male gender, tumor size, perineural invasion, and occult metastatic disease were individually associated with higher rates of loco-regional recurrence. There was no significant difference in loco-regional recurrence between those who underwent elective neck dissection and those who did not (HR=0.76, p=0.52). On cost analysis, neck dissection was not associated with any significant difference in Medicare payments.
  
  
  CONCLUSIONS
  The high rate of occult metastasis (23%) following elective neck dissection, which did not confer additional healthcare costs, leads to the recommendation of elective neck dissection in patients with cT1N0 oral tongue squamous cell carcinoma.
authors.affiliation: Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave CHS 62-132, Los Angeles, CA.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Peng
authors.affiliation: Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave CHS 62-132, Los Angeles, CA.
authors.forename: Alan C
authors.initials: AC
authors.lastname: Chu
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada.
authors.forename: Chi
authors.initials: C
authors.lastname: Lai
authors.affiliation: Department of Biostatistics, UCLA School of Public Health, 911 Broxton Ave, Los Angeles, CA.
authors.forename: Tristan
authors.initials: T
authors.lastname: Grogan
authors.affiliation: Department of Biostatistics, UCLA School of Public Health, 911 Broxton Ave, Los Angeles, CA.
authors.forename: David
authors.initials: D
authors.lastname: Elashoff
authors.affiliation: Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave CHS 62-132, Los Angeles, CA; Jonsson Comprehensive Cancer Center, UCLA, 8-684 Factor Building, Los Angeles, CA; UCLA Head and Neck Cancer Program, 200 Medical Plaza, Suite 550, Los Angeles, CA.
authors.forename: Elliot
authors.initials: E
authors.lastname: Abemayor
authors.affiliation: Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave CHS 62-132, Los Angeles, CA; Jonsson Comprehensive Cancer Center, UCLA, 8-684 Factor Building, Los Angeles, CA; UCLA Head and Neck Cancer Program, 200 Medical Plaza, Suite 550, Los Angeles, CA. Electronic address: mstjohn@mednet.ucla.edu.
authors.forename: Maie A
authors.initials: MA
authors.lastname: St John
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000191:economics / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017281:Cost of Illness; D005260:Female; D006258:Head and Neck Neoplasms / Q000191:economics / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D037981:Neck Dissection; D009361:Neoplasm Invasiveness; D011379:Prognosis; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D014062:Tongue Neoplasms / Q000191:economics / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014481:United States
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