title: Risk factors and treatment of contralateral neck recurrence for unilateral oral squamous cell carcinoma: a retrospective study of 1482 cases.
abstract: BACKGROUND
  The aim of this study was to describe risk factors of contralateral neck recurrence (CLNR) and to identify its high-risk population after treatment for unilateral oral squamous cell carcinoma.
  
  
  METHODS
  Between June 1991 and June 2012, a total of 1482 eligible patients who were treated with radical surgery with or without adjuvant therapy were retrospectively reviewed.
  
  
  RESULTS
  The outcome assessment parameters were the rate of 5-year CLNR and the rate of disease-specific survival (DSS). In the entire study cohort, the 5-year CLNR rate was 4.1%. In a multivariate analysis, only extracapsular spread (ECS) status (hazard ratio [HR]: 12.978, 95% confidence interval [CI]: 1.328-126.829, P=0.028) was an independent risk factor for 5-year CLNR. In addition, 5-year CLNR (HR: 36.410, 95% CI: 7.093-186.914, P<0.001), T stage (HR: 3.475, 95% CI: 1.151-10.488, P=0.027) and growth pattern (HR: 4.831, 95% CI: 1.776-13.140, P=0.002) were independent risk factors for 5-year DSS. Patients with at least two risk factors were identified as a high-risk population for CLNR; these patients also had a poor prognosis. Elective contralateral neck dissection (ND) plus concurrent chemoradiotherapy (CCRT) can improve the 5-year DSS in these high-risk patients, but it does not decrease the 5-year CLNR rate.
  
  
  CONCLUSIONS
  For low- and moderate-risk patients, contralateral neck observation should be considered sufficient if strict compliance with a cancer surveillance protocol is followed. However, whether high-risk patients benefit from contralateral ND plus adjuvant CCRT can only be answered in a prospective trial.
authors.affiliation: Department of Oral and Maxillofacial Surgery, School of Stomatology, Peking University, Beijing 100081, China.
authors.forename: Zhien
authors.initials: Z
authors.lastname: Feng
authors.affiliation: Department of Oral and Maxillofacial Surgery, School of Stomatology, Peking University, Beijing 100081, China.
authors.forename: Li Xuan
authors.initials: LX
authors.lastname: Niu
authors.affiliation: Department of Oral and Maxillofacial Surgery, School of Stomatology, Peking University, Beijing 100081, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Yuan
authors.affiliation: Department of Oral and Maxillofacial Surgery, School of Stomatology, Peking University, Beijing 100081, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Peng
authors.affiliation: Department of Oral and Maxillofacial Surgery, School of Stomatology, Peking University, Beijing 100081, China. Electronic address: guodazuo@sina.com.
authors.forename: Chuan Bin
authors.initials: CB
authors.lastname: Guo
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology*; D009333:Neck / Q000473:pathology*; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Contralateral neck recurrence; Lymph nodal metastasis; Neck dissection; Oral squamous cell carcinoma; Prognosis; Risk factor