title: Impact of Nodal Level Distribution on Survival in Oral Cavity Squamous Cell Carcinoma: A Population-Based Study.
abstract: Regional lymph node metastasis is an important prognostic factor in squamous cell carcinoma of the head and neck, decreasing survival by up to 50%. Oral cavity squamous cell carcinoma (OC-SCCa) most commonly spreads to levels I, II, and III.
  
  
  
  Retrospective analysis of a population-based tumor registry.
  
  
  
  Academic medical center.
  
  
  
  The Surveillance, Epidemiology, and End Results (SEER) database was queried for cases of OC-SCCa from 2004 to 2011 (22,973 cases). Resulting data including patient demographics, clinicopathological features, topographical distribution of nodal metastasis, and survival based on lymph node level involvement were analyzed.
  
  
  
  In total, 8281 patients were identified with OC-SCCa who underwent neck dissection. Level I, closely followed by levels II and III, represented the most commonly involved nodal basins. The 5-year disease-specific survival (DSS) for patients with only level I, II, or III was 42.0% compared with 30.6% for the level IV group (P < .0001) and 26.4% for the level V group (P < .0001). Surgery with adjuvant radiotherapy improved 5-year DSS for patients with level I to III, level IV, and level V neck disease compared with surgery alone (50.7% vs 48.6%, P = .0109; 39.9% vs 23.2%, P < .0001; and 33.3% vs 9.1%, P = .0005, for levels I-III, IV, and V, respectively).
  
  
  
  Oral cavity squamous cell carcinoma most commonly involves nodal levels I, II, and III. Involvement of nodal level IV or V portends a worse prognosis than patients with only level I to III disease, and multimodality therapy should be considered for these patients.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Marchiano
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
authors.forename: Tapan D
authors.initials: TD
authors.lastname: Patel
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
authors.forename: Soly
authors.initials: S
authors.lastname: Baredes
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA cwp39@njms.rutgers.edu.
authors.forename: Richard Chan Woo
authors.initials: RC
authors.lastname: Park
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology* / Q000628:therapy; D037981:Neck Dissection; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018426:SEER Program; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: SEER database; epidemiology; neck cancer; neck dissection; regional metastasis; sex; squamous cell carcinoma; survival